Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension.

Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3 ± 12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e' velocity, a' velocity, and E/e' ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P = 0.003), interventricular septum (P = 0.001), LV posterior wall thickness (P = 0.001) and E/e' ratio (P ˂ 0.001), but a decrease in e' velocity (P = 0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11-1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.

PROGNOSTIC SIGNIFICANCE AND LIMITATION OF VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN PATIENTS WITH REDUCED EJECTION FRACTION: A MINI-REVIEW.

Visit-to-visit variability (VVV) of blood pressure (BP) can facilitate in predicting future reduced ejection fractions cases. In the recent past, the prognostic significance of visitto-visit variability of BP has been examined widely in patients with a high risk of cardiovascular disease. The findings of numerous investigations have indicated that increased visit-to-visit variability of blood pressure can lead to better estimation or proper treatments that can minimize blood pressure variability and associated risks while enhancing clinical outcomes. However, inconsistent data of the visit-to-visit hypothesis in the post-hoc analysis have also been explored. Therefore, this review discusses recent analysis, background, and reports of the limitations of visit-to-visit blood pressure variability (VVV-BP) and the prognostic significance of visit-to-visit blood pressure variability in populations at high risk of reduced ejection fractions in predictions of future vascular diseases. The role of the antihypertensive drugs is highlighted while describing the clinical implications and future research directions.