The Relation Of Left Ventricular Hypertrophy With C Reactive Protein In Essential Hypertension And The Therapeutic Effect Of Telmisartan

OBJECTIVE:C Reactive Protein (CRP), a marker of chronic low-grade systemic inflammation, is a predictor of untoward cardiovascular prognosis.Also, its levels are generally elevated in patients with hypertension, and high CRP level may even precede and predict the development of arterial hypertension.More and more study indicate that CRP may not just be a predictor of hypertension, but also a mediator of this disease, it has been hypothesized that hypertension may be in part an inflammatory disorder. Higher levels of CRP may increase BP by reducing nitric oxide and prostaglandin production in endothelial cells, resulting in vasoconstriction and increased ptoduction of endothelin 1. CRP may also function as a proathero- sclerotic factor by up-regulating angiotensin type 1 receptor expression. Inflammation has been shown to correlate with endothelial dysfunction and relate to the renin-angiotensin system. As a result, apart from a predictor of cardiovascular risk, CRP also as a marker of the results of therapy. Several studies have shown that RAS inhibitors lower the CRP level while lowering blood pressure. These findings, along with basic capacity evidence, have led to the hypothesis that,in addition to the capacity to lower BP, RAS inhibition may also have anti-inflammatory properties that are important for the prognosis, prevention, and treatment of CVD. Although left ventricular hypertrophy (LVH) is one of the important complication of ·5·hypertension, no study has specifically examined the possible relationship between plasma CRP level and LVH in hypertension. The aim of this study was to examine whether elevated CRP levels are associated with LVH and, if so, whether CRP-lowering therapy would halt the progression of LVH with essential hypertension.METHODS: A total of 49 hypertension patients were screened. Body surface area (BSA kg/m2) was estimated according to Briars's equation. Random blood samples were obtained from each patient for determination of blood cell analysis,creatinine (Cr), cholesterol, triglyceride, plasma glucose,high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and hsCRP levels at baseline and at 12-month follow-up. Left ventricular mass (LVM) was determined by directed M-mode echocardiography (ECHO) according to the data reported by Devereux et al. LVH was defined according to the standard of Devereux. The diagnosis of LVH was defined by left ventricular mass indexed to body surface area >125 g/m2 in men and >110 g/m2 in women. We divided the patients into two group,non-LVH group (23 patients)and LVH group (26 patients) by the LVMI.All hypertensive patients received a dose of Telmisartan therapy (80mg/day) treatment. After 24 weeks, blood pressure, hsCRP and LVMI were observed. Statistical analyses were performed using SAS software.The difference were analysed by t test.RESULTS: There were no obvious differences in age, sex, glucose, serum lipid among the two groups. The hsCRP, IVSTd, LVDd, LVPWTd and LVMI of LVH group were higher than the non- LVH group. Correlation analysis show that CRP was correlated with LVMI. Age, gender, serum lipid, glucose were not independent predictors of LVMI. After 24 weeks of therapy with Temisasrtan in patients, blood pressure decreased significantly. hsCRP dcreased obviously in the non-LVH and LVH groups after the treatment. LVDd, IVSTd, LVPWTd, LVMI decreased significantly in LVH group.CONCLUSION: The CRP level in LVH group is higher than the non-LVH group in hypertension.Plasma CRP level is an independent risk factor for the development of LVH in essential hypertension. Telmisatan treatment can decrease the incident LVH by reducing CRP. The data provide evidence that inflammation may be an important mechanism through which LVH develops. A strategy to reduce the risk of CVD warrants monitoring CRP levels, and in case of abnormally high levels, treatment regimens that lower CRP level should be initiated. Telmisatan is not only one of the angiotensin receptor blocker, but also has the property of excitement of PPARγ, the effect of antiinflamation beside lowing blood pressure will play an important role in the treatment of hypertension and its complication in the future.