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Chao H, He Y, Wang Q, Bai Y, Avolio A, Deng X, Zuo J. Comparison of Influence of Blood Pressure and Carotid-Femoral Pulse Wave Velocity on Target Organ Damage in Hypertension. Front Cardiovasc Med 2022; 9:934747. [PMID: 35865385 PMCID: PMC9294321 DOI: 10.3389/fcvm.2022.934747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Assessment of target organ damage (TOD) is an important part of the diagnosis and evaluation of hypertension. Carotid-femoral pulse wave velocity (cf-PWV) is considered to be the gold-standard for noninvasive arterial stiffness assessment. This study aims to analyze the risk of TOD in people with different phenotypes of peripheral blood pressure and cf-PWV. Methods The study cohort was recruited from December 2017 to September 2021 at Ruijin Hospital in Shanghai. It was divided into 4 groups according to peripheral blood pressure (pBP) and cf-PWV. TOD was assessed as carotid intima-media thickness (CIMT), chronic kidney disease (CKD), urinary albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR) and left ventricular mass index (LVMI). Results A total of 1,257 subjects (mean age 53.13 ± 12.65 years, 64.2% males) was recruited. Age, body mass index (BMI) and fasting blood glucose (FBG), as well as peripheral systolic blood pressure (pSBP), peripheral diastolic blood pressure (pDBP), peripheral pulse pressure (pPP) were significantly different in the four groups (P < 0.01). eGFR, ACR, LVMI and CIMT were significantly different among different groups (P < 0.01). The risk of ACR abnormality was significantly higher in the group with elevated pBP (P = 0.005, OR 2.264, 95%CI 1.277–4.016; and in the group with elevated pBP and cf-PWV (P = 0.003, OR 1.482, 95%CI 1.144–1.920), while left ventricular hypertrophy (LVH) was significantly higher in the group with elevated cf-PWV (P = 0.002, OR 1.868, 95%CI 1.249–2.793). Conclusion Different profiles based on the status of PBP and cf-PWV associated with different TOD. Individuals with higher pBP have an increased risk of ACR abnormality, while individuals with only cf-PWV elevated have a higher risk of LVH.
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Affiliation(s)
- Huijuan Chao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan He
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaya Bai
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Xueqin Deng
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xueqin Deng
| | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Macquarie Medical School, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- *Correspondence: Junli Zuo
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Vasan RS, Short MI, Niiranen TJ, Xanthakis V, DeCarli C, Cheng S, Seshadri S, Mitchell GF. Interrelations Between Arterial Stiffness, Target Organ Damage, and Cardiovascular Disease Outcomes. J Am Heart Assoc 2019; 8:e012141. [PMID: 31303106 PMCID: PMC6662123 DOI: 10.1161/jaha.119.012141] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023]
Abstract
Background Excess transmission of pressure pulsatility caused by increased arterial stiffness may incur microcirculatory damage in end organs (target organ damage [TOD] ) and, in turn, elevate risk for cardiovascular disease ( CVD ) events. Methods and Results We related arterial stiffness measures (carotid-femoral pulse wave velocity, mean arterial pressure, central pulse pressure) to the prevalence and incidence of TOD (defined as albuminuria and/or echocardiographic left ventricular hypertrophy) in up to 6203 Framingham Study participants (mean age 50±15 years, 54% women). We then related presence of TOD to incident CVD in multivariable Cox regression models without and with adjustment for arterial stiffness measures. Cross-sectionally, greater arterial stiffness was associated with a higher prevalence of TOD (adjusted odds ratios ranging from 1.23 to 1.54 per SD increment in arterial stiffness measure, P<0.01). Prospectively, increased carotid-femoral pulse wave velocity was associated with incident albuminuria (odds ratio per SD 1.28, 95% CI, 1.02-1.61; P<0.05), whereas higher mean arterial pressure and central pulse pressure were associated with incident left ventricular hypertrophy (odds ratio per SD 1.37 and 1.45, respectively; P<0.01). On follow-up, 297 of 5803 participants experienced a first CVD event. Presence of TOD was associated with a 33% greater hazard of incident CVD (95% CI , 0-77%; P<0.05), which was attenuated upon adjustment for baseline arterial stiffness measures by 5-21%. Conclusions Elevated arterial stiffness is associated with presence of TOD and may partially mediate the relations of TOD with incident CVD . Our observations in a large community-based sample suggest that mitigating arterial stiffness may lower the burden of TOD and, in turn, clinical CVD .
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Affiliation(s)
- Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Section of Preventive MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Section of CardiologyDepartment of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public HealthBostonMA
| | - Meghan I. Short
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Teemu J. Niiranen
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Department of MedicineTurku University Hospital and University of TurkuFinland
- Department of Public Health SolutionsNational Institute for Health and WelfareTurkuFinland
| | - Vanessa Xanthakis
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Section of Preventive MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | | | - Susan Cheng
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCA
| | - Sudha Seshadri
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Biggs Institute for Alzheimer's DiseaseUniversity of Texas Health Sciences Center at San AntonioTX
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Feng L, Khan AH, Jehan I, Allen J, Jafar TH. Albuminuria and kidney function as prognostic marker of left ventricular mass among South Asians with hypertension. ACTA ACUST UNITED AC 2017; 11:811-822.e2. [PMID: 29089200 PMCID: PMC5736364 DOI: 10.1016/j.jash.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/28/2017] [Accepted: 10/01/2017] [Indexed: 01/19/2023]
Abstract
We aimed to evaluate the association of albuminuria and estimated glomerular filtration rate (eGFR) at baseline and changes in these parameters with left ventricular mass index (LVMI) at 7 years in adults with hypertension from communities in Pakistan. A nested cohort of 539 hypertensives aged 40 years and older from a community-living population in Karachi, Pakistan, followed up for 7 years in the Control of Blood Pressure and Risk Attenuation trial. Urine spot albumin-to-creatinine ratio (UACR) and serum creatinine-based eGFR were assessed at baseline and 7 years, and echocardiography at 7 years. Mean age of participants was 50.9 ± 9.1 (standard deviation) years; 63% were female. Mean eGFR was 91.0 ± 15.9 (standard deviation) mL/min/1.73 m2 and median (interquartile range) UACR 6.2 (3.9, 11.3) mg/g. In multivariate analysis, although baseline eGFR was marginally associated with LVMI, a strong association was found between higher LVMI with greater rate of decline in eGFR (β = -1.05; 95% confidence interval [CI]: [-1.94, -0.17]). Higher baseline UACR was significantly associated with higher follow-up LVMI (β = 2.26; 95% CI: [0.87, 3.65]), as was rate of UACR increase of ≥1.07 mg/g/y versus of <0.14 mg/g/y. (β = 4.19; 95% CI: [0.75, 7.63]). Associations with developing left ventricular hypertrophy were found for reduced baseline eGFR, higher baseline UACR, and greater rate of UACR increase, but not for rate of eGFR decline. Comparable results were observed for the outcomes of posterior wall thickness and septal wall thickness. Higher baseline albuminuria, lower baseline eGFR, and their longitudinal worsening were significantly associated with higher LVMI or the development of left ventricular hypertrophy among individuals with hypertension in Pakistan.
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Affiliation(s)
- Liang Feng
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Aamir Hameed Khan
- Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Imtiaz Jehan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - John Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Tazeen H Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore; Duke Global Health Institute, Duke University, Durham, NC, USA.
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Zhang J, Fallahzadeh MK, McCullough PA. Aging Male Spontaneously Hypertensive Rat as an Animal Model for the Evaluation of the Interplay between Contrast-Induced Acute Kidney Injury and Cardiorenal Syndrome in Humans. Cardiorenal Med 2016; 7:1-10. [PMID: 27994597 DOI: 10.1159/000447542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although there are some animal models for biomarkers of contrast-induced acute kidney injury (CI-AKI), for cardiorenal syndrome (CRS) and for acute renal failure, the interplay between CI-AKI and CRS has yet to be evaluated. Insight into the pathogenesis of CRS is urgently needed from animal models in order to foster the discovery and implementation of novel biomarkers for this disease. Specially designed animal models for type 1 and 3 CRS, particularly CI-AKI, have not yet emerged. SUMMARY We hypothesize that the aging male spontaneously hypertensive rat (SHR) is likely to be a suitable model. The SHR model is able to mimic risk factors for preclinical CRS that appears in the clinical setting, specifically hypertension, age, preexisting damage and dysfunction of the heart and kidney, endothelial dysfunction, increased level of reactive oxygen species, decreased level and bioavailability of nitric oxide (NO), impairment of the L-arginine-NO pathway, and insulin resistance. In the SHR, CI-AKI results in a different profile of AKI biomarkers than is seen with preexisting chronic kidney injury. KEY MESSAGES The SHR model can be used to evaluate the interaction between CI-AKI and CRS type 1 and 3 and to verify neutrophil gelatinase-associated lipocalin (NGAL) as a reliable CI-AKI biomarker for clinical application. Further research is warranted with a large number of aging male SHRs to prove NGAL as a sensitive, specific, highly predictive, early biomarker for CI-AKI.
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Affiliation(s)
- Jun Zhang
- Baylor Heart and Vascular Institute, Dallas, Tex., USA
| | | | - Peter A McCullough
- Baylor Heart and Vascular Institute, Dallas, Tex., USA; Department of Internal Medicine, Baylor University Medical Center, Dallas, Tex., USA; Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Tex, Tex., USA; The Heart Hospital Baylor Plano, Plano, Tex., USA
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Tsioufis C, Tsiachris D, Kasiakogias A, Dimitriadis K, Petras D, Goumenos D, Siamopoulos K, Stefanadis C. Preclinical cardiorenal interrelationships in essential hypertension. Cardiorenal Med 2013; 3:38-47. [PMID: 23946723 DOI: 10.1159/000346817] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A diseased heart causes numerous adverse effects on kidney function, and vice versa renal disease can significantly impair cardiac function. Beyond these heart-kidney interrelationships at the clinical level, a reciprocal association has been suggested to exist even in the early stages of those organs' dysfunction. The aim of the present review is to provide evidence of the presence of a preclinical cardiorenal syndrome in the particular setting of essential hypertension, focusing on the subsequent hypertensive sequelae on heart and kidneys. In particular, a plethora of studies have demonstrated not only the predictive role of kidney damage, as expressed by either decreased glomerular filtration or increased urine albumin excretion, for adverse left ventricular functional and structural adaptations but also preclinical heart disease, i.e. left ventricular hypertrophy that is associated with deterioration of renal function. Notably, these reciprocal interactions seem to exist even at the level of microcirculation, since both coronary flow reserve and renal hemodynamics are strongly related with clinical and preclinical renal and cardiac damage, respectively. In this preclinical setting, common pathophysiological denominators, including the increased hemodynamic load, sympathetic and renin-angiotensin system overactivity, increased subclinical inflammatory reaction, and endothelial dysfunction, account not only for the reported associations between overt cardiac and renal damage but also for the parallel changes that occur in coronary and renal microcirculation.
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Forlemu A, Menanga A, Ashuntantang G, Kingue S. Urinary protein excretion is associated with left ventricular hypertrophy in treatment-naïve hypertensive patients in an african hospital setting. Cardiorenal Med 2013; 3:57-62. [PMID: 23801999 PMCID: PMC3678147 DOI: 10.1159/000349938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 02/11/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is an independent predictor of fatal and non-fatal cardiovascular events in hypertensive patients. Current guidelines for the management of hypertension are based on cardiovascular risk stratification. This study evaluated the possibility that an inexpensive, simple random, single-void urinary protein-to-creatinine ratio (UPCR) would be associated to left ventricular (LV) mass in a black African setting, and therefore direct appropriate management of these patients. METHODS We measured echocardiographic LV mass and a random spot UPCR in 34 untreated newly diagnosed hypertensive patients attending the cardiology consultation unit at the Yaoundé General Hospital. LV mass was indexed to height (in m(2.7)) to obtain the LV mass index (LVMI). A regression model was used to verify the independent association between UPCR and LVMI. RESULTS The mean age of our patients was 52.65 years, and the mean systolic and diastolic blood pressures were 152.44 and 92.84 mm Hg, respectively. The prevalence of LVH was 41.2%. UPCR was higher in patients with LVH compared to those without (p = 0.043). There was a significant correlation between UPCR and LVMI (r = 0.581, p < 0.001). In the multiple linear regression model, UPCR was associated with LVMI independent of systolic blood pressure (p < 0.001). CONCLUSION Random spot UPCR is associated with an increased LV mass and may be very useful in screening and guiding appropriate management of high-risk untreated hypertensive patients.
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Affiliation(s)
- Arnold Forlemu
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
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Left ventricular mass index as a predictor of new-onset microalbuminuria in hypertensive subjects: a prospective study. Am J Hypertens 2012; 25:1195-201. [PMID: 22932703 DOI: 10.1038/ajh.2012.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We aimed to investigate the predictive role of left ventricular mass and its reduction on the development of new-onset microalbuminuria (MA) in newly diagnosed hypertensive patients. METHODS A total of 207 nondiabetic, normoalbuminuric patients without clinical organ damage (aged 50.8 ± 10.1 years, 132 male, 84 smokers) with baseline office blood pressure (BP) 148/96 mm Hg were followed for a mean period of 3.3 ± 1.3 years. At baseline and last follow-up visit, all patients underwent office and 24-h ambulatory BP monitoring, albumin to creatinine ratio (ACR) determination, and echocardiographic assessment of left ventricular mass index (LVMI). All patients were treated with antihypertensive therapy during the follow-up period. We defined MA as ACR between 20 and 300 mg/g for men and 30-300 mg/g for women, effective BP control as office BP <140/90 mm Hg in ≥75% of total number of visits, and LVMI reduction as the decline of LVMI at end-follow-up of ≥15% with respect to the baseline value. RESULTS Between baseline and last follow-up visit, LVMI decreased by 6.84 ± 21.5 g/m(2) (P < 0.01); 64.3% (n = 133) of participants achieved BP control during the follow-up period. Of the total population, 5.8% (n = 12) developed MA during follow-up. Cox-regression analysis, after adjustment for clinical variables, revealed that increase of LVMI by 1 s.d. (23.3 g/m(2)) conferred a 15% increased risk of new-onset MA, while LVMI reduction and BP control were both associated with almost 100% reduced risk of MA development. CONCLUSIONS LVMI and its reduction were qualified as predictors of new-onset MA in newly diagnosed hypertensive patients, beyond BP control.
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Current world literature. Curr Opin Cardiol 2012; 27:441-54. [PMID: 22678411 DOI: 10.1097/hco.0b013e3283558773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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