Impact of pulse pressure on degree of cardiac hypertrophy in patients with chronic uraemia

OBJECTIVE: To evaluate the degree of cardiac hypertrophy in patients with end-stage renal disease (ESRD) in comparison with that in patients with uncomplicated hypertension and in patients with peripheral vascular disease (PVD), at the same values of mean blood pressure. DESIGN: Thirty-six ambulatory hypertensive patients were investigated, 11 with ESRD, 14 with PVD and 11 with uncomplicated hypertension, matched for age, sex, mean arterial pressure and antihypertensive drug treatment. METHODS: Cardiac mass was determined using M-mode echocardiography together with measurement of systemic blood pressure and the ratio between ankle and arm systolic blood pressures. RESULTS: At the same mean arterial pressure, patients with ESRD developed a greater degree of cardiac hypertrophy in comparison with those with uncomplicated hypertension (P < 0.01) and patients with PVD (P < 0.05). The pulse pressure was significantly greater in patients with ESRD than in those with uncomplicated hypertension (P< 0.01) and those with PVD (P< 0.05). Multiple regression analysis showed that only pulse pressure was positively correlated to cardiac mass (r= 0.62, P< 0.001), suggesting a predominant impact of pulse pressure on left ventricular mass in patients with ESRD. CONCLUSIONS: In patients with chronic uraemia, left ventricular hypertrophy seems to be strongly and independently associated with pulse pressure.