Skip to main content
SpringerLink
Log in

Hypertension, left ventricular hypertrophy and chronic kidney disease

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Left ventricular hypertrophy (LVH) is a cardiovascular complication highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease. LVH in CKD patients has generally a negative prognostic value, because it represents an independent risk factor for the development of arrhythmias, sudden death, heart failure and ischemic heart disease. LVH in CKD patients is secondary to both pressure and volume overload. Pressure overload is secondary to preexisting hypertension, but also to a loss of elasticity of the vessels and to vascular calcifications, leading to augmented pulse pressure. Anemia and the retention of sodium and water secondary to decreased renal function are responsible for volume overload, determining a hyperdynamic state. In particular, the correction of anemia with erythropoietin in CKD patients is advantageous, since it determines LVH reduction. Other risk factors for LVH in CKD patients are documented: some are specific to CKD, as mineral metabolism disorders (hypocalcemia, hyperphosphatemia, low serum vitamin D levels and secondary hyperparathyroidism), others are non-traditional, such as increased asymmetric dimethylarginine, oxidative stress, hyperhomocysteinemia and endothelial dysfunction that, in turn, accelerates the process of atherogenesis, triggers the inflammation and pro-thrombotic state of the glomerular and the vascular endothelium and aggravates the process of both CKD and LVH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Coresh J, Wei GL, McQuillan G, Brancati FL, Levey AS, Jones C et al (2001) Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med 161(9):1207–1216

    Article  PubMed  CAS  Google Scholar 

  2. Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG (2003) Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med 115(4):291–297

    Article  PubMed  Google Scholar 

  3. Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Ishani A et al (2009) United States renal data system 2008 annual data report. Am J Kidney Dis 53(Suppl 1):S1-374

    PubMed  Google Scholar 

  4. Hanratty R, Chonchol M, Dickinson LM, Beaty BL, Estacio RO, Mackenzie TD et al (2009) Incident chronic kidney disease and the rate of kidney function decline in individuals with hypertension (2010). Nephrol Dial Transplant 25(3):801–807

    Article  PubMed  Google Scholar 

  5. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 15–21, 365(9455): 217–223

    Google Scholar 

  6. Ravera M, Re M, Deferrari L, Vettoretti S, Deferrari G (2006) Importance of blood pressure control in chronic kidney disease. J Am Soc Nephrol 17(42):S98–S103

    Article  PubMed  Google Scholar 

  7. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD et al (2008) Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American heart association professional education committee of the council for high blood pressure research. Circulation 117(25):e510–e526

    Article  PubMed  Google Scholar 

  8. Campese VM, Mitra N, Sandee D (2006) Hypertension in renal parenchymal disease: why is it so resistant to treatment? Kidney Int 69(6):967–973

    Article  PubMed  CAS  Google Scholar 

  9. Wong ND, Lopez VA, L’Italien G, Chen R, Kline SE, Franklin SS (2007) Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med 167(22):2431–2436

    Article  PubMed  Google Scholar 

  10. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305

    Article  PubMed  CAS  Google Scholar 

  11. Bakris GL, Ritz E (2009) The message for World Kidney Day 2009: hypertension and kidney disease–a marriage that should be prevented. J Hypertens 27(3):666–669

    Article  PubMed  CAS  Google Scholar 

  12. Ruilope LM, Salvetti A, Jamerson K, Hansson L, Warnold I, Wedel H et al (2001) Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study. J Am Soc Nephrol 12(2):218–225

    PubMed  CAS  Google Scholar 

  13. Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S (2001) Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 134(8):629–636

    PubMed  CAS  Google Scholar 

  14. Pontremoli R, Sofia A, Ravera M, Nicolella C, Viazzi F, Tirotta A et al (1997) Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC Study. Microalbuminuria: a Genoa investigation on complications. Hypertension 5:1135–1143

    Google Scholar 

  15. Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, Levy D (1999) Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 56(6):2214–2219

    Article  PubMed  CAS  Google Scholar 

  16. Arnlov J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D et al (2005) Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 112(7):969–975

    Article  PubMed  Google Scholar 

  17. Leoncini G, Viazzi F, Parodi D, Vettoretti S, Ratto E, Ravera M et al (2003) Mild renal dysfunction and subclinical cardiovascular damage in primary hypertension. Hypertension 42(1):14–18

    Article  PubMed  CAS  Google Scholar 

  18. Vallance P, Leone A, Calver A, Collier J, Moncada S (1992) Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. Lancet 339(8793):572–575

    Article  PubMed  CAS  Google Scholar 

  19. Converse RL Jr, Jacobsen TN, Toto RD, Jost CM, Cosentino F, Fouad-Tarazi F et al (1992) Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 327(27):1912–1918

    Article  PubMed  Google Scholar 

  20. Mallamaci F, Tripepi G, Maas R, Malatino L, Boger R, Zoccali C (2004) Analysis of the relationship between norepinephrine and asymmetric dimethyl arginine levels among patients with end-stage renal disease. J Am Soc Nephrol 15(2):435–441

    Article  PubMed  CAS  Google Scholar 

  21. Dhaun N, Goddard J, Webb DJ (2006) The endothelin system and its antagonism in chronic kidney disease. J Am Soc Nephrol 17(4):943–955

    Article  PubMed  CAS  Google Scholar 

  22. Krapf R, Hulter HN (2009) Arterial hypertension induced by erythropoietin and erythropoiesis-stimulating agents (ESA). Clin J Am Soc Nephrol 4(2):470–480

    Article  PubMed  CAS  Google Scholar 

  23. London GM, Marchais SJ, Guerin AP (2004) Arterial stiffness and function in end-stage renal disease. Adv Chronic Kidney Dis 11(2):202–209

    Article  PubMed  Google Scholar 

  24. Yildiz A, Memisoglu E, Oflaz H, Yazici H, Pusuroglu H, Akkaya V et al (2005) Atherosclerosis and vascular calcification are independent predictors of left ventricular hypertrophy in chronic haemodialysis patients. Nephrol Dial Transplant 20(4):760–767

    Article  PubMed  Google Scholar 

  25. Ibels LS, Alfrey AC, Huffer WE, Craswell PW, Anderson JT, Weil R (1979) Arterial calcification and pathology in uremic patients undergoing dialysis. Am J Med 66(5):790–796

    Article  PubMed  CAS  Google Scholar 

  26. Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr et al (1995) A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the committee on vascular lesions of the council on arteriosclerosis, American Heart Association. Arterioscler Thromb Vasc Biol 15(9):1512–1531

    Article  PubMed  CAS  Google Scholar 

  27. Guerin AP, London GM, Marchais SJ, Metivier F (2000) Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 15(7):1014–1021

    Article  PubMed  CAS  Google Scholar 

  28. Nichols WW, Edwards DG (2001) Arterial elastance and wave reflection augmentation of systolic blood pressure: deleterious effects and implications for therapy. J Cardiovasc Pharmacol Ther 6(1):5–21

    Article  PubMed  CAS  Google Scholar 

  29. Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE et al (1996) Blood pressure and end-stage renal disease in men. N Engl J Med 334(1):13–18

    Article  PubMed  CAS  Google Scholar 

  30. Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D et al (1999) Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 34(1):125–134

    Article  PubMed  CAS  Google Scholar 

  31. Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC et al (1995) Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 47(1):186–192

    Article  PubMed  CAS  Google Scholar 

  32. Middleton RJ, Parfrey PS, Foley RN (2001) Left ventricular hypertrophy in the renal patient. J Am Soc Nephrol 12(5):1079–1084

    PubMed  CAS  Google Scholar 

  33. Shlipak MG, Fried LF, Cushman M, Manolio TA, Peterson D, Stehman-Breen C, et al. (2005) Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA 13, 293(14): 1737–1745

    Google Scholar 

  34. London GM (2003) Cardiovascular disease in chronic renal failure: pathophysiologic aspects. Semin Dial 16(2):85–94

    Article  PubMed  Google Scholar 

  35. Hayashi SY, Rohani M, Lindholm B, Brodin LA, Lind B, Barany P et al (2006) Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant 21(1):125–132

    Article  PubMed  Google Scholar 

  36. Hunter JJ, Chien KR (1999) Signaling pathways for cardiac hypertrophy and failure. N Engl J Med 341(17):1276–1283

    Article  PubMed  CAS  Google Scholar 

  37. Dilsizian V, Fink JC (2008) Deleterious effect of altered myocardial fatty acid metabolism in kidney disease. J Am Coll Cardiol 51(2):146–148

    Article  PubMed  CAS  Google Scholar 

  38. Andress DL (2006) Vitamin D in chronic kidney disease: a systemic role for selective vitamin D receptor activation. Kidney Int 69(1):33–43

    Article  PubMed  CAS  Google Scholar 

  39. Nami R, Ferro G, Gianni G, Mondillo S, Gonnelli S, Montagnani A et al (1997) Calciotropic hormones and cardiovascular function in chronic renal failure. In: Timio M, Wizemann V, Nenanzi S (eds) Cardionephrology, vol 4. Editoriale Bios, Cosenza, pp 83–85

    Google Scholar 

  40. Rostand SG, Drueke TB (1999) Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int 56(2):383–392

    Article  PubMed  CAS  Google Scholar 

  41. Smogorzewski M, Zayed M, Zhang YB, Roe J, Massry SG (1993) Parathyroid hormone increases cytosolic calcium concentration in adult rat cardiac myocytes. Am J Physiol 264(6 Pt 2):H1998–H2006

    PubMed  CAS  Google Scholar 

  42. London GM (2002) Left ventricular alterations and end-stage renal disease. Nephrol Dial Transplant 17(Suppl 1):29–36

    Article  PubMed  Google Scholar 

  43. Park CW, Oh YS, Shin YS, Kim CM, Kim YS, Kim SY et al (1999) Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis 33(1):73–81

    Article  PubMed  CAS  Google Scholar 

  44. O’Connell TD, Berry JE, Jarvis AK, Somerman MJ, Simpson RU (1997) 1, 25-Dihydroxyvitamin D3 regulation of cardiac myocyte proliferation and hypertrophy. Am J Physiol 272(4 Pt 2):H1751–H1758

    PubMed  Google Scholar 

  45. Lemmila S, Saha H, Virtanen V, Ala-Houhala I, Pasternack A (1998) Effect of intravenous calcitriol on cardiac systolic and diastolic function in patients on hemodialysis. Am J Nephrol 18(5):404–410

    Article  PubMed  CAS  Google Scholar 

  46. Kim HW, Park CW, Shin YS, Kim YS, Shin SJ, Kim YS et al (2006) Calcitriol regresses cardiac hypertrophy and QT dispersion in secondary hyperparathyroidism on hemodialysis. Nephron Clin Pract 102(1):c21–c29

    Article  PubMed  Google Scholar 

  47. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP (2002) 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 110(2):229–238

    PubMed  CAS  Google Scholar 

  48. Kristal-Boneh E, Froom P, Harari G, Ribak J (1997) Association of calcitriol and blood pressure in normotensive men. Hypertension 30(5):1289–1294

    PubMed  CAS  Google Scholar 

  49. London GM, Guerin AP, Verbeke FH, Pannier B, Boutouyrie P, Marchais SJ et al (2007) Mineral metabolism and arterial functions in end-stage renal disease: potential role of 25-hydroxyvitamin D deficiency. J Am Soc Nephrol 18(2):613–620

    Article  PubMed  CAS  Google Scholar 

  50. Jono S, Shioi A, Ikari Y, Nishizawa Y (2006) Vascular calcification in chronic kidney disease. J Bone Miner Metab 24(2):176–181

    Article  PubMed  Google Scholar 

  51. Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM (2000) Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant 15(Suppl 3):14–18

    PubMed  Google Scholar 

  52. Silverberg DS, Wexler D, Blum B, Iaina A (2003) Anemia in chronic kidney disease and congestive heart failure. Blood Purif 21(1):124–130

    Article  PubMed  CAS  Google Scholar 

  53. Levin A, Djurdjev O, Thompson C, Barrett B, Ethier J, Carlisle E et al (2005) Canadian randomized trial of hemoglobin maintenance to prevent or delay left ventricular mass growth in patients with CKD. Am J Kidney Dis 46(5):799–811

    Article  PubMed  CAS  Google Scholar 

  54. Weiner DE, Tighiouart H, Vlagopoulos PT, Griffith JL, Salem DN, Levey AS et al (2005) Effects of anemia and left ventricular hypertrophy on cardiovascular disease in patients with chronic kidney disease. J Am Soc Nephrol 16(6):1803–1810

    Article  PubMed  Google Scholar 

  55. Paoletti E, Cannella G (2006) Left ventricular hypertrophy in chronic kidney disease. G Ital Nefrol 23(6):560–568

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Pisa, Pisa, Italy

    Stefano Taddei & Rosa Maria Bruno

  2. Department of Internal Medicine, University of Siena, Siena, Italy

    Renato Nami, Ilaria Quatrini & Ranuccio Nuti

Authors
  1. Stefano Taddei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renato Nami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosa Maria Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilaria Quatrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ranuccio Nuti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renato Nami.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taddei, S., Nami, R., Bruno, R.M. et al. Hypertension, left ventricular hypertrophy and chronic kidney disease. Heart Fail Rev 16, 615–620 (2011). https://doi.org/10.1007/s10741-010-9197-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-010-9197-z

Keywords

Search

Navigation