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Lower nitric oxide (NOx) levels are independently associated with impaired left ventricular global longitudinal strain (LV-GLS) and albuminuria in hypertensive patients without renal impairment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 3, 2026Open Access

The role of nitric oxide in hypertensive target organ damage in patients without renal impairment: insights from left ventricular global longitudinal strain and albuminuria

Key Result

Lower nitric oxide (NOx) levels were independently associated with impaired LV-GLS (OR 0.817) and albuminuria (OR 0.905) in hypertensive patients without renal impairment.

Key Points

Lower nitric oxide levels correlate with reduced left ventricular global longitudinal strain and increased albuminuria.
In a sample of 400 hypertensive patients, lower levels of nitrite/nitrate indicated organ dysfunction.
Assessment included transthoracic echocardiography to evaluate cardiac function and spot urine samples for albumin/creatinine ratio measurement.
Findings suggest that nitric oxide levels may serve as a biochemical marker for renal and myocardial impairment in hypertension.

Structured PICO

Are lower nitrite/nitrate (NOx) levels associated with subclinical myocardial and renal dysfunction in adult hypertensive patients?

Population

400 adult hypertensive patients without end-stage renal disease requiring dialysis or other conditions potentially confounding cardiac or renal assessment

Intervention

Nitrite/nitrate (NOx) levels measured from blood samples

Outcome

Subclinical myocardial and renal dysfunction assessed by left ventricular global longitudinal strain (LV-GLS) and urine albumin/creatinine ratio (UACR)surrogate

Lower nitric oxide levels are independently associated with impaired LV-GLS and albuminuria, highlighting its potential as a biomarker for subclinical hypertensive target organ damage.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Hypertension (HT) is a prevalent chronic condition that contributes significantly to morbidity and mortality by leading to target organ damage. Although nitric oxide (NO) underpins endothelial function and has been implicated in several cardiovascular conditions, its association with subclinical hypertension-mediated organ damage remains unclear. This study aimed to investigate the relationship between nitrite/nitrate (NOx)—an indirect index of NO pathways and subclinical myocardial and renal dysfunction in patients with HT. This study prospectively screened 433 adult hypertensive patients, of whom 400 were included in a cross-sectional analysis after exclusion of conditions potentially confounding cardiac or renal assessment, including end-stage renal disease requiring dialysis. All participants underwent transthoracic echocardiography to assess ventricle functions using left ventricular global longitudinal strain (LV-GLS) and provided a spot urine sample for the measurement of the urine albumin/creatinine ratio (UACR). In addition to NOx levels, inducible and endothelial nitric oxide synthase levels were evaluated from participants’ blood samples. NOx levels were significantly associated with reduced LV-GLS and higher UACR values. In multivariate analysis, lower NOx levels were independently associated with impaired LV-GLS (OR: 0.817; 95% CI: 0.783–0.853; p < 0.001) and albuminuria (OR: 0.905; 95% CI: 0.877–0.934; p < 0.001). NOx may represent an independent biochemical parameter associated with subclinical myocardial and renal dysfunction in patients with HT.

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