Inadequate RAAS suppression is associated with excessive left ventricular mass and systo-diastolic dysfunction

• Published in: Clinical research in cardiology Vol. 102; no. 10; pp. 725 - 733
• Main Authors: Gregori, Mario, Tocci, Giuliano, Marra, Andrea, Pignatelli, Giulia, Santolamazza, Caterina, Befani, Alberto, Ciavarella, Giuseppino Massimo, Ferrucci, Andrea, Paneni, Francesco
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2013; Springer Nature B.V
• Subjects: Adult; Aldosterone - blood; Blood Pressure Monitoring, Ambulatory; Cardiology; Cross-Sectional Studies; Echocardiography, Doppler; Female; Heart Ventricles - physiopathology; Humans; Hypertension - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Posture; Prevalence; Regression Analysis; Renin - blood; Renin-Angiotensin System - physiology; Supine Position; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Remodeling; Renin–angiotensin system; Heart failure; Arterial hypertension; Left ventricular dysfunction; Tissue Doppler imaging; Inappropriate left ventricular mass
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-013-0585-y

Background Inadequate suppression of renin–angiotensin–aldosterone system (RAAS) following postural maneuvers may have detrimental effects on cardiac structure and function. In this study, we aimed to appraise the clinical significance of this phenomenon by assessing its relation with inappropriate ventricular mass (ILVM), an adverse phenotype of LV remodeling and dysfunction. Methods Both supine and upright plasma renin activity (PRA) and aldosterone concentrations (PAC) were measured in 115 young newly diagnosed hypertensive subjects. 24-h ambulatory blood pressure monitoring and echocardiographic evaluation including tissue Doppler imaging (TDI) were also performed. Patients were divided as follows: (1) normal PRA and PAC (N) ( n  = 63); (2) suppressible RAAS (SR) in supine position ( n  = 27); (3) not suppressible RAAS (NSR) ( n  = 25). ILVM was expressed as the observed/predicted LV mass ratio ×100 (%PLVM), while LV dysfunction (LVD) was identified by TDI-derived myocardial performance index (MPI). Results NSR showed a higher prevalence of ILVM than SR and N. As compared with N and SR, NSR patients had reduced indices of systolic and diastolic function. MPI of the LV as well as prevalence of LVD was also significantly higher in the NSR group. Regression models showed that lack of RAAS suppression was independently associated with ILVM and LVD. Conclusions Prevalence of ILVM and LVD is higher in patients without clinostatic RAAS suppression. Our findings encourage the assessment of RAAS deregulation to better estimate individual cardiovascular risk in patients with arterial hypertension.