Abstract
Renal dysfunction is frequently associated with left ventricular (LV) hypertrophy and diastolic dysfunction in hypertensive patients. Limited data exist on renal dysfunction and diastolic impairment among British ethnic minorities with hypertension. We studied associations between renal impairment and diastolic dysfunction in hypertensive subjects of African-Caribbean and South Asian origin. Five hundred and ten hypertensive subjects with ejection fraction ⩾55% and with no history of ischaemic heart disease/valve pathology were included from the original population of the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). Diastolic function and cardiac remodelling were measured by echocardiography. LV hypertrophy was common and present in 62% of patients with normal estimated glomerular filtration rate (eGFR, >90 ml min−1 per 1.73 m2), 73% in those with eGFR 60–89 ml min−1 per 1.73 m2 and 87% with eGFR <60 ml min−1 per 1.73 m2. On both univariate and multivariable linear regression, reduced eGFR was associated with higher LV mass index (LVMI, P=0.01 and P=0.039, respectively). On multivariable analyses, increased LVMI (but not eGFR) was an independent predictor of echocardiographic parameters of diastolic dysfunction. Higher LVMI was an independent predictor of all-cause or cardiovascular death on multivariable analyses (both P=0.002), but not eGFR. LV hypertrophy is common in minority ethnic groups with hypertension, especially in the presence of renal dysfunction. Increased LVMI rather than renal impairment per se is a major determinant of diastolic dysfunction and increased risk of cardiovascular or all-cause death among hypertensive patients without end-stage renal failure.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol 2007; 50 (8): 768–777.
Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J et al. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Cardiac Fail 2007; 13 (6): 422–430.
Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006; 17 (7): 2034–2047.
Di Lullo L, Floccari F, Polito P . Right ventricular diastolic function in dialysis patients could be affected by vascular access. Nephron Clin Pract 2011; 118 (3): c257–c261.
Glassock RJ, Pecoits-Filho R, Barberato SH . Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol 2009; 4 (Suppl 1): S79–S91.
Gill PS, Calvert M, Davis R, Davies MK, Freemantle N, Lip GY . Prevalence of heart failure and atrial fibrillation in minority ethnic subjects: the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). PLoS One 2011; 6 (11): e26710.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7 (2): 79–108.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009; 10 (2): 165–193.
Butt M, Khair OA, Dwivedi G, Shantsila A, Shantsila E, Lip GY . Myocardial perfusion by myocardial contrast echocardiography and endothelial dysfunction in obstructive sleep apnea. Hypertension 2011; 58 (3): 417–424.
London GM . Left ventricular alterations and end-stage renal disease. Nephrol Dial Transplant 2002; 17 (Suppl 1): 29–36.
Ritz E, Wanner C . The challenge of sudden death in dialysis patients. Clin J Am Soc Nephrol 2008; 3 (3): 920–929.
Gross ML, Ritz E . Hypertrophy and fibrosis in the cardiomyopathy of uremia—beyond coronary heart disease. Semin Dial 2008; 21 (4): 308–318.
Ritz E . Left ventricular hypertrophy in renal disease: beyond preload and afterload. Kidney Int 2009; 75 (8): 771–773.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP . Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322 (22): 1561–1566.
Silberberg JS, Barre PE, Prichard SS, Sniderman AD . Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int 1989; 36 (2): 286–290.
Dorn GW II . Apoptotic and non-apoptotic programmed cardiomyocyte death in ventricular remodelling. Cardiovasc Res 2009; 81 (3): 465–473.
Steigerwalt S, Zafar A, Mesiha N, Gardin J, Provenzano R . Role of aldosterone in left ventricular hypertrophy among African-American patients with end-stage renal disease on hemodialysis. Am J Nephrol 2007; 27 (2): 159–163.
Zoccali C, Benedetto FA, Tripepi G, Mallamaci F . Cardiac consequences of hypertension in hemodialysis patients. Semin Dial 2004; 17 (4): 299–303.
Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Stancanelli B et al. Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int 2004; 65 (4): 1492–1498.
Harnett JD, Foley RN, Kent GM, Barre PE, Murray D, Parfrey PS . Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int 1995; 47 (3): 884–890.
London GM, Pannier B, Guerin AP, Blacher J, Marchais SJ, Darne B et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol 2001; 12 (12): 2759–2767.
Acknowledgements
We are grateful to all the subjects, practice staff including receptionists, nurses, managers and general practitioners for taking part in this study. We are grateful to Dr Mikhail Dzeshka for coding of diastolic function. General Practice Centres: Rotton Park Medical Centre, City Road Medical Practice, Cavendish Medical Practice, Ann Jones Family Health Centre, Shanklin House Surgery, Burbury Street Surgery, Heathford Group Practice, Broadway Health Centre, Victoria Road Medical Centre, Churchill Medical Centre, St Clements Surgery, Handsworth Medical Centre, Soho Health Centre, Church Road Surgery, Bloomsbury Health Centre, Al-Shafa Medical Practice, Enki Medical Practice, Aston Pride Health Centre, Newtown Health Centre, Hockley Medical Centre. This work was supported by the British Heart Foundation (PG/05/036), Heart of Birmingham Teaching Primary Care Trust and through the National Health Service R&D support funding (Primary Care Research Network-Central England). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Shantsila, A., Shantsila, E., Gill, P. et al. Renal dysfunction and diastolic impairment among British ethnic minorities with hypertension: the Ethnic-Echocardiographic Heart of England Screening Study. J Hum Hypertens 31, 206–211 (2017). https://doi.org/10.1038/jhh.2016.68
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jhh.2016.68