Abnormal regulation of renin angiotensin aldosterone system is associated with right ventricular dysfunction in hypertension

Mario Gregori, Giuliano Tocci, Benedetta Giammarioli, Alberto Befani, Giuseppino Massimo Ciavarella, Andrea Ferrucci, Francesco Paneni

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Right ventricular dysfunction (RVD) is a major predictor of cardiovascular mortality. Inadequate suppression of the renin-angiotensin-aldosterone system (RAAS) after postural manoeuvres favours alterations of left ventricular (LV) function. The effects of RAAS dysregulation on RV performance remain elusive. The present study investigated RV function in hypertensive patients with or without altered RAAS activation. Methods: Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured in 104 newly diagnosed hypertensive patients after both supine and upright positioning to assess dynamic changes of RAAS induced by antigravitational stress. Twenty-four-hour ambulatory blood pressure monitoring and echocardiographic evaluation of the right ventricle including tissue Doppler imaging (TDI) were performed. Patients were divided as follows: (1) normal PRA and PAC (N group [n = 58]), (2) suppressible RAAS after supine positioning (SR group [n = 24]), and (3), nonsuppressible RAAS (NSR group [n = 22]). RVD was identified by the TDI-derived myocardial performance index (MPI) calculated with a multisegmental approach. Results: Patients in the NSR group had reduced indices of RV function compared with patients in the N and SR groups. MPI of the right ventricle as well as prevalence of RVD were also significantly higher in the NSR group. Regression models showed that inadequate RAAS suppression was independently associated with RVD, regardless of blood pressure values and LV dysfunction (LVD). Conclusions: Patients without supine normalization of RAAS display a significant impairment of RV function. Our findings suggest that a dynamic RAAS evaluation may help to identify hypertensive patients at higher risk of RVD.

Original languageEnglish
Pages (from-to)188-194
Number of pages7
JournalCanadian Journal of Cardiology
Volume30
Issue number2
DOIs
Publication statusPublished - Feb 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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