Detecting early LVH in at-risk blacks Dr Wendy S Post Assistant Professor of Medicine Division of Cardiology Johns Hopkins Hospital Baltimore, 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:

Patients with microalbuminuria*22% Sensitivity**33% Specificity82% 3 of 4 *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:

“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 2 of 4 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.