Inadequate RAAS suppression is associated with excessive left ventricular mass and systo-diastolic dysfunction

Mario Gregori, Giuliano Tocci, Andrea Marra, Giulia Pignatelli, Caterina Santolamazza, Alberto Befani, Giuseppino Massimo Ciavarella, Andrea Ferrucci, Francesco Paneni

Research output: Contribution to journalArticlepeer-review


Background: Inadequate suppression of renin-angiotensin-aldosterone system (RAAS) following postural maneuvers may have detrimental effects on cardiac structure and function. In this study, we aimed to appraise the clinical significance of this phenomenon by assessing its relation with inappropriate ventricular mass (ILVM), an adverse phenotype of LV remodeling and dysfunction. Methods: Both supine and upright plasma renin activity (PRA) and aldosterone concentrations (PAC) were measured in 115 young newly diagnosed hypertensive subjects. 24-h ambulatory blood pressure monitoring and echocardiographic evaluation including tissue Doppler imaging (TDI) were also performed. Patients were divided as follows: (1) normal PRA and PAC (N) (n = 63); (2) suppressible RAAS (SR) in supine position (n = 27); (3) not suppressible RAAS (NSR) (n = 25). ILVM was expressed as the observed/predicted LV mass ratio ×100 (%PLVM), while LV dysfunction (LVD) was identified by TDI-derived myocardial performance index (MPI). Results: NSR showed a higher prevalence of ILVM than SR and N. As compared with N and SR, NSR patients had reduced indices of systolic and diastolic function. MPI of the LV as well as prevalence of LVD was also significantly higher in the NSR group. Regression models showed that lack of RAAS suppression was independently associated with ILVM and LVD. Conclusions: Prevalence of ILVM and LVD is higher in patients without clinostatic RAAS suppression. Our findings encourage the assessment of RAAS deregulation to better estimate individual cardiovascular risk in patients with arterial hypertension.

Original languageEnglish
Pages (from-to)725-733
Number of pages9
JournalClinical Research in Cardiology
Issue number10
Publication statusPublished - Oct 2013


  • Arterial hypertension
  • Heart failure
  • Inappropriate left ventricular mass
  • Left ventricular dysfunction
  • Renin-angiotensin system
  • Tissue Doppler imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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