Interrelationship between left ventricular hypertrophy and progression of renal disease in diabetic nephropathy

Diabetes mellitus (DM) and its many complications are major causes of morbidity and mortality. The purpose of this review is to examine the relationships between left ventricular hypertrophy (LVH) and diabetic nephropathy (DN). LVH is a component of the insulin resistance syndrome even in the absence of hypertension. DM is a strong predictor of cardiovascular (CV) disease and may be associated with LVH even in the absence of hypertension. In a large study of hypertensive subjects with LVH there was an increased risk for microalbuminuria and overt proteinuria. This was also evident in those subjects with DM. In patients with DN there is a positive association between LVH and albuminuria. A new analysis of data from the Reduction of Endpoints in MIDDM with Angiotensin II Antagonist (RENAAL) study has shown that in patients with DN the presence of LVH was a significant risk factor for CV and mortality and for the progression of DN. Antihypertensive therapy with different agents has caused a regression in LVH. Moreover, in the RENAAL study treatment with a angiotensin receptor blocker was associated with a significant improvement in both the cardiac and renal risk. The presence of DN