Angiotensin II as an Indicator of Left Ventricular Hypertrophy in Uncontrolled Treated Hypertensive Patients

Abstract

H ypertension is a common health problem worldwide and in Africa especially in Egypt. It causes a financial burden on developing countries due to its long term cardiovascular complications which are high in prevalence in Egypt as the survey showed due to low awareness rates. Only 38% of all Egyptian hypertensive patients were aware of having high blood pressure and only 24% of them were receiving treatment. (1) Hypertension affects most of body organs and most importantly the heart causing LVH which is defined as an increase in the mass of the left ventricle, whether due to an increase in wall thickness which is called “Concentric LVH” (RWT > 0.42), or an increase in cavity size which is called “Eccentric LVH” (RWT < 0.42). (14,15) Many previous studies tried to investigate the role of Ag II in development of LVH whether through its direct effect on the cardiomyocytes or by increasing cardiac afterload. This study was conducted on 91 patients who were referred to Ain Shams University hospital for Echocardiography from February 2015 to December 2015. All the patients had uncontrolled essential hypertension for five years at least and were receiving medical treatment. Uncontrolled hypertension was defined as systolic BP ≥140 and diastolic BP ≥90 measured on two different visits at least 2 weeks apart. (102) The patients were categorized into 2 groups according to presence of LVH by echocardiography. Group (1) included 47 patients with concentric LVH while group (2) included 44 patients without concentric LVH. Serum Ag II level was measured in patients in both groups enzyme-linked immunosorbent assay (ELISA) and any value exceeding 30 pg/ml was considered a high value. (109) We compared both groups regarding age, sex, anthropometric data, blood pressure measurements, duration of hypertension, echocardiographic findings and antihypertensive medications both groups were on. Our study showed that Ag II serum level was high in both groups but was significantly higher in patients with LVH (p=0.00) who although were on medical treatment (Mono therapy 25.5%,dual 57.5%,triple 17%) developed LVH. Our study also showed that LVH was more common in males who also had significantly higher LVMI than females (p= 0.019). Diabetic patients were nearly equal in both groups and had non-significantly higher LVMI than non-diabetic patients (p=0.277).