Document Detail

Sympathetic activity in chronic kidney disease patients is related to left ventricular mass despite antihypertensive treatment.
MedLine Citation:
PMID:  20360012     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chronic kidney disease (CKD) patients often have sympathetic hyperactivity, which contributes to the pathogenesis of hypertension and cardiovascular organ damage. Angiotensin-converting enzyme (ACE) inhibitors (ACEi) and angiotensin II receptor blockers (ARB) reduce sympathetic hyperactivity. Ideally, treatment should eliminate the relation between sympathetic activity and organ damage. The aim of the present study is firstly to compare left ventricular mass (LVM) of CKD patients using chronic ACEi or an ARB with LVM of controls. Secondly, we determine whether previously found muscle sympathetic nerve activity (MSNA) and arterial blood pressure during follow-up are predictive for the presence of increased LVM. Methods. We restudied 20 CKD patients and 30 healthy volunteers matched for age. Sympathetic nerve activity was quantified by the microneurography (MSNA). Arterial blood pressure was the mean of office blood pressure measurements. LVM was quantified by magnetic resonance imaging (MRI) without contrast.
RESULTS: The period between MSNA and MRI measurements was 9 ± 3 years. All patients were treated according to guidelines with an ACEi or an ARB. In CKD patients, mean systolic and diastolic arterial pressure were 129 ± 10 and 84 ± 5 mmHg, respectively, during follow-up. In patients, as compared to controls, LVM was 93 ± 16 versus 76 ± 18 g, LVM index 30 ± 5 versus 24 ± 4 g/m(2.7) and mean wall thickness 11 ± 2 versus 9.0 ± 1 mm (all P < 0.01). Moreover, MSNA was related to LVM (r = 0.65, P < 0.002), LVM index (r = 0.46, P < 0.03) and LV mean wall thickness (r = 0.84, P < 0.001). Conclusions. In conclusion, the present study demonstrates that measures of LVM in CKD patients are greater than in healthy controls, despite a well-controlled blood pressure in the patients. Moreover, there is a positive relationship between these measures of LVM and MSNA, assessed years before, despite a standard antihypertensive treatment. These results support the notion that additional sympatholytic therapy could be beneficial.
Laima Siddiqi; Niek H Prakken; Birgitta K Velthuis; Maarten J Cramer; P Liam Oey; Peter Boer; Michiel L Bots; Peter J Blankestijn
Publication Detail:
Type:  Journal Article     Date:  2010-03-31
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  25     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-23     Completed Date:  2011-01-13     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  3272-7     Citation Subset:  IM    
Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands.
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MeSH Terms
Antihypertensive Agents / therapeutic use*
Chronic Disease
Hypertrophy, Left Ventricular / physiopathology*
Kidney Diseases / drug therapy,  physiopathology*
Middle Aged
Renin-Angiotensin System / drug effects,  physiology
Sympathetic Nervous System / drug effects,  physiopathology*
Reg. No./Substance:
0/Antihypertensive Agents

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