Angiotensin II as an Indicator of Left ventricular Hypertrophy in Uncontrolled Treated Hypertensive Patients
Background: left ventricular hypertrophy (LVH) in uncontrolled hypertension is a major risk factor and the mechanism is not fully understood weather it is due to increased afterload or due to an angiotensin II (Ag II) mediated action on the heart. Objectives: we studied the relationship between Ag II serum level and concentric LVH in patients with hypertension. Methods: a total of 91 patients were included, all had long standing (≥ 5 years) essential uncontrolled treated hypertension and were categorized into two groups according to presence of concentric LVH by echocardiographic criteria (LV mass index (LVMI)>115 g/ m2 for men, LVMI>95 g/m2 for women and relative wall thickness (RWT)>0.42). Group I had 47 patients with LVH and group II had 44 patients without LVH. Ag II serum level was measured in all of them. Results: Ag II serum level was higher than normal range in all patients in both groups (cutoff value was taken as 30pg/ml). It was significantly higher in patients with LVH (group I) with mean level 70 pg/ml compared to 43 pg/ml in patients without LVH (group II) (p=0.000). In patients with LVH, Ag II serum level had positive correlation with BMI (r=0.325, P=0.026) but it had no correlation to age, gender, diabetes, duration of hypertension and, surprisingly no correlation to severity of LVH. Conclusion: Patients with LVH have higher serum level of Ag II compared to patients without LVH but it cannot be considered as the only causative factor for LVH in hypertensive patients and other factors should be considered.