Left Ventricular Hypertrophy In Patients With Renal Hypertension And The Analysis Of Risk Factors

Background and objective Renal hypertension is very frequent in secondary hypertension.Hypertension is a risk facter in the progression of CRF,and it is also the main modifiable determinant of cardiovascular risk. Prevention of cardiovascular disease (CVD) is now recognized as the main goal of conservative treatment of chronic kidney disease (CKD). In CKD patients, cardiovascular risk rises proportionally to the decline of renal function and becomes remarkable when glomerular filtration rate (GFR) is below 60 ml/min/1.73m~2 .The impact of cardiovascular complications is so important that the risk for fatal and nonfatal cardiovascular events overcomes that for renal disease progression. Our study try to explore the aetiology and antihypertension treatment of renal hypertension, evaluate the prevalence and patterns of left ventricular hypertrophy(LVH) in patients of renal hypertension(RHT) and analyse the relationship between LVH and various predisposing factors. Methods Total 298 renal hypertension are recruited. We collect clinical and histological dates and analysis the aetiology and treatment of hypertension. We also investigate 239 renal hypertension patients.They have stages 1 to 5 CKD.The clinic and biochemical characteristics are collected. Left ventricular mass index(LVMI) is assessed by means of echocardiography. The relative wall thickness and the presence or absence of echocardiographic LVH are used to determine the various geometric patterns. Accoding to LVMI , the RHT patients were divided into two groups: RHT with LVH and RHT without LVH. Results Firstly,primary glomerulonephritis is the most popular reason of renal hypertension,the following are secondary renal disease, tubulointerstitial nephropathy ,and polycystic renal disease.IgA nephritis is the most commonprimary glomerulonephritis which is the reason of renal hypertension,and diabetic nephrotis is the most common secondary renal disease . Overall, 82.2% are awared of renal hypertension,77.2% are treated, and rate under control is 34.6%. The rate of awareness tends to increase with age,while the rate of treatment and control decrease.Following the lost of renal function, the rate of awareness and treatment increase ,but the number of control decrease. The prescription of angiotension converting enzyme inhibitor overcomes other drugs,including angiotension II receptor blokers.The prescription of rennin-angiotension system inhibitors significant decrease from stage 1 to 5,whereas that the uses of calcium channel blockers slightly increase.The number of prescribed drugs per patient increase when the renal function lost. Secondly,the prevalence of LVH is 50.2%, it is increasing from CKD 1 to 5,respectedly 26.7% ,39.5%,48%,61.5% and 69.4%. There are significant difference in duration of hypertension, systolic body pressure, pulse pressure, mean body pressure, hemoglobin, calcium-phosphate product and serum creatinine between LVH group and without LVH group. The logistic regression analysis shows that duration of renal hypertension,systolic pressure and hemoglobin are the most important predictors of LVH. Eccentric hypertrophy is the main pattern of LVH. Conclusion The aetiology of renal hypertension are mainly primary glomerulonephritis, and IgA nephritis is the usual reason.The awareness,treatment and control of renal hypertension are not satisfied. Combined antihypertension is needed mostly.The prevalence of LVH in renal hypertension is high,and it is increasing with the worsen of renal function. Duration of renal hypertension, systolic pressure and hemoglobin are the most important predictors of LVH.