Dr Wendy S Post

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Detecting early LVH in at-risk blacks

• Dr Wendy S Post
• Assistant Professor of Medicine
• Division of Cardiology
• Johns Hopkins Hospital
• Baltimore, MD

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Detecting early LVH in blacks
State of the problem

• 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.

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Detecting early LVH in blacks
Study population

• 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
131168-1172
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Detecting early LVH in blacks
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Study findings
Increased ACR as predictor of increased LVH
p-value 0.05 For ACR gt30mg/g as diagnosis of
echocardiographic LVH
Post WS, et.al., Am J of Hypertens 2000
131168-1172
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Distal protection devices
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Importance

• 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 Post
• Assistant Professor of Medicine
• Division of Cardiology
• Johns Hopkins Hospital
• Baltimore, MD

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Detecting early LVH in blacks
What next?

• Men will be followed for 5 years
• Confirmation is needed in different populations
  before this could be considered as a routine
  screening test

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Detecting early LVH in blacks
Cost analysis

• No cost analyses have been done yet
• May be a source of savings since echocardiographs
  are too expensive for the majority of
  hypertension patients

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Detecting early LVH in blacks
Independence from blood pressure

• 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 lt .003)

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Distal protection devices
Daytime void

• 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.