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Left Ventricular Anatomy and Function in Primary Aldosteronism and Renovascular Hypertension

  • Achille C. Pessina
  • Alfredo Sacchetto
  • Gian Paolo Rossi
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 432)

Summary

Left ventricular hypertrophy (LVH) is a common finding in hypertension and represents a detrimental outcome since it is associated with increased morbidity and mortality. For similar elevation of blood pressure the severity and type of LVH vary considerably in relation to several factors. Compelling evidence suggests that both the renin-angiotensin system (RAS) and the aldosterone excess play an important role in the pathogenesis of LVH, since experimentally angiotensin II has been found to cause myocardial cells hypertrophy and/or hyperplasia and excess aldosterone has been related to extracellular matrix and collagen deposition and therefore to myocardial fibrosis. Secondary forms of hypertension offer models for investigating the relative role of the RAS and aldosterone on the heart in humans. Being rare in the population of hypertensive patients, they furnish an example of the so called Bateson’s approach to the understanding of diseases “Treasure your exceptions.” In this paper, we review the data concerning the LV changes in primary aldosteronism and renovascular hypertension and discuss the insight that they have provided into the pathogenesis of LVH.

Keywords

Primary Aldosteronism Renovascular Hypertension Essential Hypertensive Patient Essential Hypertensive Excess Aldosterone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Liebson PR, Grandits G, Prineas R, Dianzumba S, Flack JM, Cutler JA, Grimm R, Stamler J: Echocardiography correlates of left ventricular structure among 844 mildly hypertensive men and women in the Treatment of Mild Hypertension Study (TOMHS). Circulation 1993; 87:476–486.PubMedCrossRefGoogle Scholar
  2. 2.
    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; 322:1561–1566.PubMedCrossRefGoogle Scholar
  3. 3.
    Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH: Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114:345–352.PubMedGoogle Scholar
  4. 4.
    White WB, Dey HM, Schulman P: Assessment of the daily blood pressure load as a determinant of cardjac function in patients with mild-to-moderate hypertension. Am Heart J 1989; 118:782–795.PubMedCrossRefGoogle Scholar
  5. 5.
    Morgan HE, Baker KM: Cardiac hypertrophy. Mechanical, neural, and endocrine dependence. Circulation 1991; 83: 13–25.PubMedCrossRefGoogle Scholar
  6. 6.
    Iwai N, Ohmichi N, Nakamura Y, Kinoshita M: DD genotype of the angiotensin-converting enzyme gene is a risk factor for left ventricular hypertrophy. Circulation 1994; 90:2622–2628.PubMedCrossRefGoogle Scholar
  7. 7.
    Geisterfer AA, Peach MJ, Owens GK: Angiotensin II induces hypertrophy, not hyperplasia, of cultured rat aortic smooth muscle cells. Circ Res 1988; 62:749–756.PubMedCrossRefGoogle Scholar
  8. 8.
    Weber KT: Cardiac interstitium in health and disease: the fibrillar collagen network. J Am Coll Cardiol 1989; 13:1637–1652.PubMedCrossRefGoogle Scholar
  9. 9.
    Weber KT, Sun Y, Campbell SE, Slight SH, Ganjam VK, Griffing GT, Swinfard RW, Diaz-Arias AA: Chronic mineralocorticoid excess and cardiovascular remodeling. Steroids 1995; 60:125–132.PubMedCrossRefGoogle Scholar
  10. 10.
    Jalil JE, Doering CW, Janicki JS, Pick R, Clark WA, Abrahams C, Weber KT: Structural vs. contractile protein remodeling and myocardial stiffness in hypertrophied rat left ventricle. J Mol Cell Cardiol 1988; 20: 1179–1187.PubMedCrossRefGoogle Scholar
  11. 11.
    Weber KT, Brilla CG, Campbell SE: Regulatory mechanisms of myocardial hypertrophy and fibrosis: results of in vivo studies. Cardiology 1992; 81:266–273.PubMedCrossRefGoogle Scholar
  12. 12.
    Weber KT, Janicki JS, Pick R, Abrahams C, Shroff SG, Bashey RI, Chen, RM. Collagen in the hypertrophied, pressure-overloaded myocardium. Circulation 1987; 75:140–7.Google Scholar
  13. 13.
    Weber KT, Brilla CG, Janicki JS, Reddy HK, Campbell SE: Myocardial fibrosis: role of ventricular systolic pressure, arterial hypertension, and circulating hormones. Basic Res Cardiol 1991; 86Suppl 3:25–31.PubMedGoogle Scholar
  14. 14.
    Brilla CG, Zhou G, Matsubara L, Weber KT: Collagen metabolism in cultured adult rat cardiac fibroblasts: response to angiotensin II and aldosterone. J Mol Cell Cardiol 1994; 26:809–820.PubMedCrossRefGoogle Scholar
  15. 15.
    Young M, Fullerton M, Dilley R, Funder J: Mineralocorticoids, hypertension, and cardiac fibrosis. J Clin Invest 1994; 93:2578–2583.PubMedCrossRefGoogle Scholar
  16. 16.
    Tarazi RC, Ibrahim M, Bravo EL, Dustan HP: Hemodynamic characteristics of primary aldosteronism. N Engl J Med 1973; 289:1330–1335.PubMedCrossRefGoogle Scholar
  17. 17.
    Rossi GP, Sacchetto A, Visentin P, Canali C, Graniero GR, Palatini P, Pessina AC: Changes in left ventricular anatomy and function in hypertension and primary aldosteronism. Hypertension 1996; 27:1039–1045.PubMedCrossRefGoogle Scholar
  18. 18.
    Shimizu G, Hirota Y, Kita Y, Kawamura K, Saito T, Gaasch WH: Left Ventricular wall mechanics in systemic arterial hypertension: myocardial function is depressed in pressure-overload hypertrophy. Circulation 1991; 83:1676–1684.PubMedCrossRefGoogle Scholar
  19. 19.
    de Simone G, Devereux RB, Roman MJ, Ganau A, Saba PS, Alderman MH, Laragh JH: Assessment of Left ventricular function by the Midwall Fractional Shortening/End-Systolic Stress relation in human hypertension. J Am Coll Cardiol 1994; 23:1444–1451.PubMedCrossRefGoogle Scholar
  20. 20.
    de Simone G, Devereux RB, Koren MJ, Mensah GA, Casale PN, Laragh JH: Midwall Left Ventricular mechanics. An independent predictor of cardiovascular risk in essential hypertension. Circulation 1996; 93: 259–265.PubMedCrossRefGoogle Scholar
  21. 21.
    Rossi GP, Sacchetto A, Pavan E, Palatini P, Graniero GR, Canali C, Pessina AC: Remodeling of the left ventricle in primary aldosteronism due to Conn’s adenoma. Circulation 1997; 95: 1471–1478.PubMedCrossRefGoogle Scholar
  22. 22.
    Denolle T, Chatellier G, Julien J, Battaglia C, Luo P, Plouin PF: Left ventricular mass and geometry before and after etiologic treatment in renovascular hypertension, aldosterone-producing adenoma, and pheochromocytoma. Am J Hypertens 1993; 6:907–913.PubMedGoogle Scholar
  23. 23.
    Shigematsu Y, Hamada M, Okayama H, Hara Y, Hayashi Y, Kodama K, Kohara K, Hiwada K: Left ventricular hypertrophy precedes other target-organ damage in primary aldosteronism. Hypertension 1997; 29:723–727.PubMedCrossRefGoogle Scholar
  24. 24.
    Rossi G, Rossi A, Zanin L, Calabro A, Crepaldi G, Pessina AC: Prevalence of extracranial carotid artery lesions at duplex in primary aldosteronism. Am J Hypertens 1993; 6:8–14.PubMedGoogle Scholar
  25. 25.
    Rossi GP, Rossi E, Pavan E, Rosati N, Zecchel R, Sacchetto A, Perazzolo F, Semplicini A, Pessina AC: Identification of Conn’s adenoma (CA) with a multivariate discriminant analysis (MDA). Am J Hypertens 1997; in press: (Abstract).Google Scholar
  26. 26.
    Halimi JM, Mimran A: Albuminuria in untreated patients with primary aldosteronism or essential hypertension. J Hypertens 1995; 13:1801–1802.PubMedGoogle Scholar
  27. 27.
    Alderman MH, Madhavan S, Ooi WL, Cohen H, Sealey JE, Laragh JH: Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. N Engl J Med 1991; 324:1098–1104.PubMedCrossRefGoogle Scholar
  28. 28.
    Brunner HR, Laragh JH, Baer L, Newton MA, Goodwin FT, Krakoff LR, Bard RH, Buhler FR: Essential hypertension: renin and aldosterone, heart attack and stroke. N Engl J Med 1972; 286:441–449.PubMedCrossRefGoogle Scholar
  29. 29.
    Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH: Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet 1988; 2:551–552.PubMedCrossRefGoogle Scholar
  30. 30.
    Vensel LA, Devereux RB, Pickering TG, Herrold EM, Borer JS, Laragh, JH. Cardiac structure and function in renovascular hypertension produced by unilateral and bilateral renal artery stenosis. Am J Cardiol 1986; 58:575–582.PubMedCrossRefGoogle Scholar
  31. 31.
    Suzuki T, Abe H, Nagata S, Saitoh F, Iwata S, Ashizawa A, Kuramochi, M, Omae T: Left ventricular structural characteristics in unilateral renovascular hypertension and primary aldosteronism. Am J Cardiol 1988; 62:1224–1227.PubMedCrossRefGoogle Scholar
  32. 32.
    Wong AK, Verdonk ED, Hoffmeister BK, Miller JG, Wickline SA: Detection of unique transmural architecture of human idiopathic cardiomyopathy by ultrasonic tissue characterization. Circulation 1992; 86: 1108–1115.PubMedCrossRefGoogle Scholar
  33. 33.
    Lucarini AR, Gigli G, Lattanzi F, Picano E, Mazzarisi A, Iannetti M, Landini L: Regression of hypertensive myocardial hypertrophy does not affect ultrasonic myocardial reflectivity: a tissue characterization study. J Hypertens. 1994; 12:73–79.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Achille C. Pessina
    • 1
  • Alfredo Sacchetto
    • 1
  • Gian Paolo Rossi
    • 1
  1. 1.Department of Clinical & Experimental MedicineUniversity of Padua Medical School and Azienda Ospedaliera di PadovaItaly

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