Relationship of left ventricular hypertrophy and diastolic function with cardiovascular and renal outcomes in African Americans with hypertensive chronic kidney disease

Gail E. Peterson, Tine De Backer, Gabriel Contreras, Xuelei Wang, Cynthia Kendrick, Tom Greene, Lawrence J. Appel, Otelio S. Randall, Janice Lea, Miroslaw Smogorzewski, Tudor Vagaonescu, Robert A. Phillips

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease. Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study. Of 691 patients enrolled in the cohort, 578 had interpretable echocardiograms and complete relevant clinical data. Exposures were LV hypertrophy and diastolic parameters. Outcomes were cardiovascular events requiring hospitalization or causing death; a renal composite outcome of doubling of serum creatinine or end-stage renal disease (censoring death); and heart failure. We found strong independent relationships between LV hypertrophy and subsequent cardiovascular (hazard ratio, 1.16; 95% confidence interval, 1.05-1.27) events, but not renal outcomes. After adjustment for LV mass and clinical variables, lower systolic tissue Doppler velocities and diastolic parameters reflecting a less compliant LV (shorter deceleration time and abnormal E/A ratio) were significantly (P<0.05) associated with future heart failure events. This is the first study to show a strong relationship among LV hypertrophy, diastolic parameters, and adverse cardiac outcomes in African Americans with hypertension and chronic kidney disease. These echocardiographic risk factors may help identify high-risk patients with chronic kidney disease for aggressive therapeutic intervention.

Original languageEnglish (US)
Pages (from-to)518-525
Number of pages8
JournalHypertension
Volume62
Issue number3
DOIs
StatePublished - Sep 1 2013

Keywords

  • African Americans
  • diastolic heart failure
  • echocardiography
  • hypertension
  • hypertrophy

ASJC Scopus subject areas

  • Internal Medicine

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    Peterson, G. E., De Backer, T., Contreras, G., Wang, X., Kendrick, C., Greene, T., Appel, L. J., Randall, O. S., Lea, J., Smogorzewski, M., Vagaonescu, T., & Phillips, R. A. (2013). Relationship of left ventricular hypertrophy and diastolic function with cardiovascular and renal outcomes in African Americans with hypertensive chronic kidney disease. Hypertension, 62(3), 518-525. https://doi.org/10.1161/HYPERTENSIONAHA.111.00904