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December 5, 1990, Vol 264, No. 21 >
ARTICLE | December 5, 1990

Glomerular Hyperfiltration Indicates Early Target Organ Damage in Essential Hypertension FREE

Roland E. Schmieder, MD; Franz H. Messerli, MD; Guillermo Garavaglia, MD; Boris Nunez, MD
[+] Author Affiliations

Reprint requests to Department of Medicine, University of Erlangen Nurnberg, Korgumazgarten 14-18, 8500 Nurnberg 80, Federal Republic of Germany (Dr Schmieder).


JAMA. 1990;264(21):2775-2780. doi:10.1001/jama.1990.03450210075036
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Article
References

In 111 patients with essential hypertension (World Health Organization stage I or II), we examined the relationship between renal hemodynamics and left ventricular hypertrophy. Left ventricular structure was determined by two-dimensional guided M-mode echocardiography, renal blood flow by iodine I 131 aminohippuric acid clearance, and glomerular filtration rate by creatinine clearance. The glomerular filtration rate correlated with left ventricular mass (r=.52) and left ventricular cross-sectional area (r=.21). Conversely, at a similar age, body mass index, body surface area, and arterial pressure, hypertensive patients with left ventricular hypertrophy disclosed a higher glomerular filtration rate and filtration fraction than those without left ventricular hypertrophy, whereas renal blood flow and renal vascular resistance measurements were not significantly different. Thus, at similar levels of arterial pressure and renal blood flow, glomerular hyperfiltration was linked to early cardiac structural changes in essential hypertension. We conclude that, in a hypertensive patient with normal renal function, a high glomerular filtration rate may be an indicator for early target organ damage in essential hypertension.

(JAMA. 1990;264:2775-2780)

REFERENCES

1 +
Huang T. Veith I, trans. Nei Ching Su Wên: The Yellow Emperor's Classic of Internal Medicine . Baltimore, Md: Williams & Wilkins; 1949;:1-253.
2 +
Hollenberg NK, Adams DF.  The renal circulation in hypertensive disease . Am J Med. 1976;;60:773-784.
3 +
Hollenberg NK, Williams GH, Adams DF.  Essential hypertension: abnormal renal vascular and endocrine responses to a mild psychological stimulus . Hypertension . 1981;;3:11-17.
4 +
Bianchi C, Cusi D, Gatti M, et al.  Renal abnormality as a possible cause of 'essential' hypertension . Lancet . 1979;;1:173-177.
5 +
Rosenberg WL.  The glomerular origin of essential hypertension . Med Hypotheses . 1983;;10: 167-171.
6 +
Kobrin I, Pegram BL, Frohlich ED.  Acute pressure increase and intrarenal hemodynamics in conscious WKY and SHR rats . Am J Physiol. 1985;; 249:H1114-H1118.
7 +
Brenner BM.  Hemodynamically mediated glomerular injury and the progressive nature of kidney disease . Kidney Int. 1983;;23:647-655.
8 +
Hostetter TH, Rennke HG, Brenner BM.  The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies . Am J Med. 1982;;72:375-380.
9 +
Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM.  Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation . Am J Physiol. 1981;;241:F85-F93.
10 +
Mogensen CE, Christensen CK.  Predicting diabetic nephropathy in insulin-dependent diabetes . N Engl J Med. 1984;;311:89-93.
11 +
Mogensen CE.  Microalbuminuria as a predictor of clinical diabetic nephropathy . Kidney Int. 1987;;31:673-689.
12 +
Messerli FH, de Carvalho JGR, Christie B, Frohlich ED.  Systemic and regional hemodynamics in low, normal and high cardiac output borderline hypertension . Circulation . 1978;;58:441-448.
13 +
Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD.  Cardiovascular effects of verapamil in patients with essential hypertension . Circulation . 1987;;75:1030-1036.
14 +
Friedman MJ, Roeske WR, Sahn DJ, Larson D, Goldberg S.  Accuracy of M-mode echocardiographic measurements of the left ventricle . Am J Cardiol. 1982;;49:716-722.
15 +
Sahn DJ, de Maria A, Kisslo J, Weyman A.  Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements . Circulation . 1978;; 58:1072-1080.
16 +
Gaash WH, Amorian WC, Levine NJ.  Chronic aortic regurgitation: the effect of aortic valve replacement on left ventricular volume, mass and function . Circulation . 1978;;58:825-836.
17 +
Troy BL, Pombo J, Rackley CE.  Measurement of left ventricular wall thickness and mass by echocardiography . Circulation . 1972;;45:602-610.
18 +
Devereux RB, Alonso DR, Lutas EM, et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings . Am J Cardiol. 1986;;57:450-458.
19 +
Teichholz LE, Kreulen T, Herman MV, Gorlin R.  Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy . Am J Cardiol. 1976;;37:7-11.
20 +
Silikas GI, Jack D, Edelman CM Jr, Chervu LR, Blaufox MD, Spitzer A.  Simultaneous measurement of glomerular filtration rate and renal plasma flow using plasma disappearance curves . J Pediatr. 1973;;83:749-757.
21 +
Tauxe WN, Maher FT, Taylor WF.  Effective renal plasma flow: estimation from the theoretical volumes of distribution of intravenously injected 131 I orthiodohippurate . Mayo Clin Proc. 1971;;46:524-531.
22 +
Cockcroft DW, Gault H.  Prediction of creatinine clearance from serum creatinine . Nephron . 1976;;16:31-41.
23 +
DuarteCG, Elveback LR, Liedtke RR.  Creatinine . In: Duarte CG, ed. Renal Function Tests: Clinical Laboratory Procedures and Diagnosis . Boston, Mass: Little Brown & Co Inc; 1980;:1-28.
24 +
Doolan PD, Alpen EL, Theil GB.  A clinical appraisal of the plasma concentration and endogenous clearance of creatinine . Am J Med. 1962;; 32:65-79.
25 +
Kim KE, Onesti G, Ramirez Q, Brest AN, Swartz C.  Creatinine clearance in renal disease: a reappraisal . BMJ . 1969;;4:11-14.
26 +
Devereux RB.  Detection of left ventricular hypertrophy in M-mode echocardiography: anatomic validation, standardization, and comparison to other methods . Hypertension . 1987;;9( (suppl 2) ):19-26.
27 +
Schmieder R, Messerli FH, Garavaglia GE, Nunez BD.  Glomerular hyperfiltration indicated target organ damage in essential hypertension . Circulation . 1987;;76( (suppl IV) ):440 Abstract.
28 +
Moritz AR, Oldt MR.  Arteriolar sclerosis in hypertensive and non-hypertensive individuals . Am J Pathol. 1937;;13:679-728.
29 +
Perera GA.  Hypertensive vascular disease: description and natural history . J Chronic Dis. 1955;;1:33-42.
30 +
Woods JB, Blythe WB, Huffines WD.  Management of malignant hypertension complicated by renal insufficiency . N Engl J Med. 1974;;291:10-13.
31 +
Schmieder RE, Messerli FH, Garavaglia G,  Schächinger H. Determinants of the decline of renal perfusion with aging in essential hypertension . In: Program and abstracts of the 13th Scientific Meeting of the International Society of Hypertension; June 24-29, 1990 ; Montreal, Quebec. Abstract, addendum S93.
32 +
Messerli FH, Sundgaard-Riise K, Ventura HO, Dunn FG, Oigmann W, Frohlich ED.  Clinical and hemodynamic determinants of left ventricular dimensions . Arch Intern Med. 1984;;144:477-481.
33 +
Messerli FH, Sundgaard-Riise K, Reisin ED, Dreslinski G, Dunn FG, Frohlich ED.  Disparate cardiovascular effects of obesity and essential hypertension . Am J Med. 1983;;74:808-812.
34 +
Julius S, Esler M.  Autonomic nervous cardiovascular regulation in borderline hypertension . Am J Cardiol. 1975;;36:685-696.
35 +
Frohlich ED, Tarazi RC.  Is arterial pressure the sole factor responsible for hypertensive cardiac hypertrophy? Am J Cardiol. 1979;;44:959-963.
36 +
Hall JE, Guyton AC, Jackson TE, Coleman TG, Lohmeier TE, Trippodo NC.  Control of glomerular filtration rate by renin-angiotensin system . Am J Physiol. 1977;;233:366-372.
37 +
Carmines PK, Perry MD, Hazelrig JB, Navar LG.  Effects of preglomerular and postglomerular vascular resistance alterations on filtration fraction . Kidney Int. 1987;;31( (suppl 20) ):229-232.
38 +
Pfeiffer JB, Wolff HG, Winter OS.  Studies in renal circulation during periods of life stress and accompanying emotional reactions in subjects with and without essential hypertension: observation on the role of neural activity in regulation of renal blood flow . J Clin Invest. 1950;;29:1227-1242.
39 +
Ganau A, Devereux RB, Atlas SA, et al.  Plasma atrial natriuretic factor in essential hypertension: relation to cardiac size, function and systemic hemodynamics . J Am Coll Cardiol. 1989;;14: 715-724.
40 +
Casale PN, Devereux RB, Milner M, et al.  Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men . Ann Intern Med. 1986;;105:173-178.
41 +
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP.  Prognostic implications of echocardiographic-determined left ventricular mass in the Framingham Heart Study . N Engl J Med. 1990;;322:1561-1566.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Huang T. Veith I, trans. Nei Ching Su Wên: The Yellow Emperor's Classic of Internal Medicine . Baltimore, Md: Williams & Wilkins; 1949;:1-253.
2 +
Hollenberg NK, Adams DF.  The renal circulation in hypertensive disease . Am J Med. 1976;;60:773-784.
3 +
Hollenberg NK, Williams GH, Adams DF.  Essential hypertension: abnormal renal vascular and endocrine responses to a mild psychological stimulus . Hypertension . 1981;;3:11-17.
4 +
Bianchi C, Cusi D, Gatti M, et al.  Renal abnormality as a possible cause of 'essential' hypertension . Lancet . 1979;;1:173-177.
5 +
Rosenberg WL.  The glomerular origin of essential hypertension . Med Hypotheses . 1983;;10: 167-171.
6 +
Kobrin I, Pegram BL, Frohlich ED.  Acute pressure increase and intrarenal hemodynamics in conscious WKY and SHR rats . Am J Physiol. 1985;; 249:H1114-H1118.
7 +
Brenner BM.  Hemodynamically mediated glomerular injury and the progressive nature of kidney disease . Kidney Int. 1983;;23:647-655.
8 +
Hostetter TH, Rennke HG, Brenner BM.  The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies . Am J Med. 1982;;72:375-380.
9 +
Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM.  Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation . Am J Physiol. 1981;;241:F85-F93.
10 +
Mogensen CE, Christensen CK.  Predicting diabetic nephropathy in insulin-dependent diabetes . N Engl J Med. 1984;;311:89-93.
11 +
Mogensen CE.  Microalbuminuria as a predictor of clinical diabetic nephropathy . Kidney Int. 1987;;31:673-689.
12 +
Messerli FH, de Carvalho JGR, Christie B, Frohlich ED.  Systemic and regional hemodynamics in low, normal and high cardiac output borderline hypertension . Circulation . 1978;;58:441-448.
13 +
Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD.  Cardiovascular effects of verapamil in patients with essential hypertension . Circulation . 1987;;75:1030-1036.
14 +
Friedman MJ, Roeske WR, Sahn DJ, Larson D, Goldberg S.  Accuracy of M-mode echocardiographic measurements of the left ventricle . Am J Cardiol. 1982;;49:716-722.
15 +
Sahn DJ, de Maria A, Kisslo J, Weyman A.  Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements . Circulation . 1978;; 58:1072-1080.
16 +
Gaash WH, Amorian WC, Levine NJ.  Chronic aortic regurgitation: the effect of aortic valve replacement on left ventricular volume, mass and function . Circulation . 1978;;58:825-836.
17 +
Troy BL, Pombo J, Rackley CE.  Measurement of left ventricular wall thickness and mass by echocardiography . Circulation . 1972;;45:602-610.
18 +
Devereux RB, Alonso DR, Lutas EM, et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings . Am J Cardiol. 1986;;57:450-458.
19 +
Teichholz LE, Kreulen T, Herman MV, Gorlin R.  Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy . Am J Cardiol. 1976;;37:7-11.
20 +
Silikas GI, Jack D, Edelman CM Jr, Chervu LR, Blaufox MD, Spitzer A.  Simultaneous measurement of glomerular filtration rate and renal plasma flow using plasma disappearance curves . J Pediatr. 1973;;83:749-757.
21 +
Tauxe WN, Maher FT, Taylor WF.  Effective renal plasma flow: estimation from the theoretical volumes of distribution of intravenously injected 131 I orthiodohippurate . Mayo Clin Proc. 1971;;46:524-531.
22 +
Cockcroft DW, Gault H.  Prediction of creatinine clearance from serum creatinine . Nephron . 1976;;16:31-41.
23 +
DuarteCG, Elveback LR, Liedtke RR.  Creatinine . In: Duarte CG, ed. Renal Function Tests: Clinical Laboratory Procedures and Diagnosis . Boston, Mass: Little Brown & Co Inc; 1980;:1-28.
24 +
Doolan PD, Alpen EL, Theil GB.  A clinical appraisal of the plasma concentration and endogenous clearance of creatinine . Am J Med. 1962;; 32:65-79.
25 +
Kim KE, Onesti G, Ramirez Q, Brest AN, Swartz C.  Creatinine clearance in renal disease: a reappraisal . BMJ . 1969;;4:11-14.
26 +
Devereux RB.  Detection of left ventricular hypertrophy in M-mode echocardiography: anatomic validation, standardization, and comparison to other methods . Hypertension . 1987;;9( (suppl 2) ):19-26.
27 +
Schmieder R, Messerli FH, Garavaglia GE, Nunez BD.  Glomerular hyperfiltration indicated target organ damage in essential hypertension . Circulation . 1987;;76( (suppl IV) ):440 Abstract.
28 +
Moritz AR, Oldt MR.  Arteriolar sclerosis in hypertensive and non-hypertensive individuals . Am J Pathol. 1937;;13:679-728.
29 +
Perera GA.  Hypertensive vascular disease: description and natural history . J Chronic Dis. 1955;;1:33-42.
30 +
Woods JB, Blythe WB, Huffines WD.  Management of malignant hypertension complicated by renal insufficiency . N Engl J Med. 1974;;291:10-13.
31 +
Schmieder RE, Messerli FH, Garavaglia G,  Schächinger H. Determinants of the decline of renal perfusion with aging in essential hypertension . In: Program and abstracts of the 13th Scientific Meeting of the International Society of Hypertension; June 24-29, 1990 ; Montreal, Quebec. Abstract, addendum S93.
32 +
Messerli FH, Sundgaard-Riise K, Ventura HO, Dunn FG, Oigmann W, Frohlich ED.  Clinical and hemodynamic determinants of left ventricular dimensions . Arch Intern Med. 1984;;144:477-481.
33 +
Messerli FH, Sundgaard-Riise K, Reisin ED, Dreslinski G, Dunn FG, Frohlich ED.  Disparate cardiovascular effects of obesity and essential hypertension . Am J Med. 1983;;74:808-812.
34 +
Julius S, Esler M.  Autonomic nervous cardiovascular regulation in borderline hypertension . Am J Cardiol. 1975;;36:685-696.
35 +
Frohlich ED, Tarazi RC.  Is arterial pressure the sole factor responsible for hypertensive cardiac hypertrophy? Am J Cardiol. 1979;;44:959-963.
36 +
Hall JE, Guyton AC, Jackson TE, Coleman TG, Lohmeier TE, Trippodo NC.  Control of glomerular filtration rate by renin-angiotensin system . Am J Physiol. 1977;;233:366-372.
37 +
Carmines PK, Perry MD, Hazelrig JB, Navar LG.  Effects of preglomerular and postglomerular vascular resistance alterations on filtration fraction . Kidney Int. 1987;;31( (suppl 20) ):229-232.
38 +
Pfeiffer JB, Wolff HG, Winter OS.  Studies in renal circulation during periods of life stress and accompanying emotional reactions in subjects with and without essential hypertension: observation on the role of neural activity in regulation of renal blood flow . J Clin Invest. 1950;;29:1227-1242.
39 +
Ganau A, Devereux RB, Atlas SA, et al.  Plasma atrial natriuretic factor in essential hypertension: relation to cardiac size, function and systemic hemodynamics . J Am Coll Cardiol. 1989;;14: 715-724.
40 +
Casale PN, Devereux RB, Milner M, et al.  Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men . Ann Intern Med. 1986;;105:173-178.
41 +
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP.  Prognostic implications of echocardiographic-determined left ventricular mass in the Framingham Heart Study . N Engl J Med. 1990;;322:1561-1566.

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