Detecting early LVH in at-risk blacks

Dr Wendy S Post Assistant Professor of MedicineDivision of CardiologyJohns Hopkins HospitalBaltimore, MD

State of the problem

Detecting early LVH in blacks

Inner city African-American men with hypertension are at greatest risk of adverse events associated with hypertension.

African-Americans also have more target organ damage related to hypertension, in this case LVH.

Study population

Detecting early LVH in blacks

109 untreated, hypertensive, young, inner city, African-American men

Echocardiographic LV mass and a random spot urinary albumin creatinine ratio (ACR) were measured

Microalbuminuria defined as ACR 30 to 300 mg/g

Post WS, et.al., Am J of Hypertens 2000; 13:1168-1172

Patients with microalbuminuria* 22%

Sensitivity** 33%

Specificity 82%

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*Increased ACR as predictor of increased LVH: p-value = 0.05**For ACR >30mg/g as diagnosis of echocardiographic LVH

Detecting early LVH in blacks

Study findings

Post WS, et.al., Am J of Hypertens 2000; 13:1168-1172

“Men who have evidence of target organ damage such as LVH should be treated most aggressively, because we know that these are the patients at greatest risk and potentially have the most to gain by aggressive medical therapy.”

Dr Wendy S PostAssistant Professor of MedicineDivision of CardiologyJohns Hopkins HospitalBaltimore, MD

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Distal protection devices Importance

What next?

Detecting early LVH in blacks

Men will be followed for 5 years

Confirmation is needed in different populations before this could be considered as a routine screening test

Cost analysis

Detecting early LVH in blacks

No cost analyses have been done yet

May be a source of savings since echocardiographs are too expensive for the majority of hypertension patients

Independence from blood pressure

Detecting early LVH in blacks

Multivariate analyses showed the ACR/LVH correlation is independent of blood pressure

Increased ACR is a predictor of increased LV mass index after multiple linear regression (P < .003)

Daytime void

Distal protection devices

First morning urine is not as accurate a reflection of a 24-hour urine, correlations of spot-urine tests to 24-hour urine are stronger with a sample taken later in the day.