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(Hypertension. 1999;34:450-456.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Left Ventricular Mass, Stroke Volume, and Ouabain-Like Factor in Essential Hypertension
From the University of Milan and Division of Nephrology, Dialysis and Hypertension, IRCCS San Raffaele Hospital (P.M., P.S., R.R., D. Ciurlino, D. Cusi, G.B.), Milan, and Prassis Research Institute Sigma-Tau (M.F.), Settimo, Milanese, Italy; and the Department of Physiology, School of Medicine, University of Maryland (J.M.H.), Baltimore.
Abstract—Many patients with
essential hypertension (EH) exhibit increased left
ventricular mass. Similarly, elevated circulating levels of
an endogenous ouabainlike factor (OLF) have been described
in some but not all patients with EH. Moreover, ouabain has a
hypertrophic influence on isolated cardiac myocytes. Accordingly, we
investigated relationships among plasma OLF, left
ventricular mass, and cardiac function in patients with EH.
Plasma OLF was determined in 110 normotensive subjects and 128 patients
with EH. Echocardiographic parameters and
humoral determinants were measured in EH. Plasma OLF levels were
increased (P<0.0001) in patients with EH (377±19
pmol/L) versus normotensive (253±53 pmol/L) subjects. The distribution
of plasma OLF was unimodal in normotensives, whereas it was bimodal in
EH. Twenty-four–hour diastolic ambulatory blood pressure
was slighter higher in EH with high OLF compared with EH with normal
OLF (93.2±1.14 versus 89.4±1.33 mm Hg, P=0.03).
Left ventricular mass index and stroke volume in EH with
high OLF were greater than in EH with normal OLF (101.9±3.3 versus
86.1±2.5 g/m2, P=0.0003, and 57.10±1.48
versus 52.30±1.14 mL/m2, P=0.02,
respectively), although heart rate was slower (74.2±1.3 versus
80.5±1.3 bpm, P=0.005). Multiple regression
analysis that tested the influence of body mass index, age,
gender, 24-hour blood pressure, and OLF on left ventricular
mass revealed independent contributions of systolic (13.2%)
and diastolic (12.4%) blood pressure and plasma OLF
(11.6%) to left ventricular mass. We conclude that 
50%
of patients with uncomplicated EH have elevated-high circulating OLF
levels, higher diastolic blood pressure, greater left
ventricular mass and stroke volume, and reduced heart rate.
We propose that the OLF affects cardiovascular function
and structure and should be considered as a factor that contributes to
the risk of morbid events.
Key Words: sodium • sodium-potassium pump • cardiac glycosides • digoxin • human • hypertension, essential • heart
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