Determinants of left ventricular remodeling in elderly patients with essential hypertension: a study of 210 cases

Objective To analyze the determinants of left ventricular remodeling in elderly patients with essential hypertension.Methods A total of 210 elderly subjects with essential hypertension were enrolled.Their fasting blood samples were collected for the measurement of lipid,glucose,creatinine,uric acid,baseline plasma renin activity,angiotensin Ⅱ,and aldosterone levels.Their clinic blood pressure,24 hour ambulatory blood pressure and echocardiography were also monitored,and left ventricular mass index（LVMI） and relative wall thickness（RWT） calculated.With the standard of LVMI＞95 g/m2（for the female）,＞115 g/m2（for the male） and RWT＞0.42,the subjects were divided into four groups: normal structure group（with normal LVMI and RWT;NS group）,concentric remodeling group（with normal LVMI and increased RWT;CR group）,concentric hypertrophy group（with increased LVMI and RWT;CH group） and eccentric hypertrophy group（with increased LVMI and normal RWT;EH group）.Results The clinic systolic blood pressure,clinic pulse pressure and ambulatory pulse pressure were increased in CH group as compared with NS group（153.5±25.1） vs（140.6±20.1） mmHg,（73.7±24.8） vs（62.2±18.0） mm Hg,（67.0±13.8） vs（56.4±11.5）mm Hg,P＜0.01.The ambulatory pulse pressure rose in EH group as compared with NS group （63.8±14.0） vs（56.4±11.5） mm Hg,P＜0.05.The ambulatory pulse pressure was statistically increased in CH group as compared with CR group （67.0±13.8） vs（57.7±14.2） mm Hg,P＜0.01.The highest level of plasma renin activity occurred in CR group.The level of plasma renin activity of EH group was higher than that of CH group.The aldosterone to renin activity ratio（ARR） in CH group and EH group was higher than that in NS group and CR group.LVMI was positively correlated with gender and 24 hour average systolic blood pressure.Conclusion Systolic blood pressure,clinic pulse pressure,24 hour ambulatory pulse pressure and renin angiotensin Ⅱ aldosterone system（RAAS） were important factors influencing ventricular remodeling in elderly hypertensive patients.