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

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Abstract

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.

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Conflict of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Cardiology Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, Via di Grottarossa, 1035-1039, Rome, Italy

    Mario Gregori, Andrea Marra, Giulia Pignatelli, Caterina Santolamazza, Alberto Befani, Giuseppino Massimo Ciavarella & Andrea Ferrucci

  2. IRCCS Neuromed, Pozzilli, Italy

    Giuliano Tocci & Francesco Paneni

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  1. Mario Gregori
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  2. Giuliano Tocci
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  9. Francesco Paneni
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Correspondence to Mario Gregori.

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Gregori, M., Tocci, G., Marra, A. et al. Inadequate RAAS suppression is associated with excessive left ventricular mass and systo-diastolic dysfunction. Clin Res Cardiol 102, 725–733 (2013). https://doi.org/10.1007/s00392-013-0585-y

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  • DOI: https://doi.org/10.1007/s00392-013-0585-y

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