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01-10-2013 | Original Paper

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

Authors: Mario Gregori, Giuliano Tocci, Andrea Marra, Giulia Pignatelli, Caterina Santolamazza, Alberto Befani, Giuseppino Massimo Ciavarella, Andrea Ferrucci, Francesco Paneni

Published in: Clinical Research in Cardiology | Issue 10/2013

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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Title: Inadequate RAAS suppression is associated with excessive left ventricular mass and systo-diastolic dysfunction
Authors: Mario Gregori
Giuliano Tocci
Andrea Marra
Giulia Pignatelli
Caterina Santolamazza
Alberto Befani
Giuseppino Massimo Ciavarella
Andrea Ferrucci
Francesco Paneni
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 10/2013
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-013-0585-y

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

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Conclusions

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