Association of aldosterone with left ventricular mass in hypertension: interaction with plasma fibrinogen levels

Background:Plasma aldosterone concentration is an independent determinant of left ventricular (LV) mass in hypertensive patients, and is related to some hemostatic variables through which it may contribute to a prothrombotic state. We conducted a study to investigate the relationship between hemostatic variables, plasma aldosterone, and cardiac morphology and function in essential hypertension. Methods: In 205 patients with untreated essential hypertension, we measured components of the renin–angiotensin–aldosterone system, plasma levels of fibrinogen, D-dimer, prothrombin fragment 1 + 2 (F1 + 2), and plasminogen activator inhibitor-1 (PAI-1), and assessed cardiac characteristics with standard echocardiography. Results: The patients were divided into two groups according to whether their median value of plasma aldosterone was > 125 pg/ml or < 125 pg/ml. Left ventricular mass index (LVMI) was significantly greater in patients with a high (> 51 ± 13 g/m2.7 ) than with a low plasma aldosterone level (< 41 ± 11 g/m2.7; P < 0.01) only in patients with fibrinogen levels in the highest tertile. Significant interaction was observed between plasma fibrinogen and aldosterone in the association with LVMI (P = 0.04). Left ventricular mass index was significantly and directly related to age, systolic blood pressure (BP), body mass index (BMI), plasma aldosterone, fibrinogen, and D-dimer levels, whereas no relationships were observed between echocardiographic parameters and other hemostatic variables. Fibrinogen was directly related to age, systolic BP, plasma aldosterone, LVMI, relative wall thickness, and left atrial diameter. Multivariate analysis indicated that LVMI was related to plasma fibrinogen and aldosterone (both P < 0.01) independently of age, BP,and BMI. Conclusions: Plasma fibrinogen levels interact with plasma aldosterone in its association with left ventricular mass in patients with hypertension.