Atherosclerosis profile and microalbuminuria in essential hypertension

Calviño, Jesús; Calvo, Carlos; Romero, Rafael; Gudé, Francisco; Sánchez-Guisande, D

doi:10.1016/s0272-6386(99)70003-x

Cited by 28 publications

(19 citation statements)

References 25 publications

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“…28) In line with this, we found that the microalbuminuria of our essential hypertensive patients was correlated with both left ventricular hypertrophy and retinopathy. These results are in line with reports by Calvino, et al and Cerasola, et al 26,29) and we suggest that microalbuminuria may be a marker of endothelial damage throughout the entire vascular system.…”

Section: Discussionsupporting

confidence: 94%

The Frequency of Combined Target Organ Damage and the Beneficial Effect of Ambulatory Blood Pressure Monitoring in Never Treated Mild-to-Moderate Hypertensive Patients

et al. 2005

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SUMMARYThe aim of this study was to determine the frequency of target organ damage (TOD) and the beneficial properties of ambulatory blood pressure monitoring (ABPM) for detecting patients who are at high risk for TOD and cardiovascular disease in never treated mild-to-moderate hypertension.Sixty-seven patients (28 males and 39 females, mean age, 49.6 ± 9.5 years) were divided into two groups, dippers (group I, n = 43) and nondippers (group II, n = 24), according to nocturnal blood pressure (BP) reduction of less than 10%. The groups were compared with respect to demographic and laboratory data and the signs of TOD (microalbuminuria, left ventricular hypertrophy, and retinopathy). We also tested the relationship between ABPM and clinic BP findings with TOD. Group I had significantly lower values than group II for serum fibrinogen (0.28 ± 0.06 versus 0.32 ± 0.06 g/L, P = 0.02), uric acid (0.18 ± 0.05 versus 0.25 ± 0.11 mmo/L, P = 0.01), urinary sodium excretion (133.7 ± 45.2 versus 161.8 ± 52.2 mmol/L, P = 0.02), urinary albumin excretion (17.5 ± 14.2 versus 31.3 ± 19.7 mg/24-h, P = 0.001), left ventricular mass index (111.8 ± 31.0 versus 128.7 ± 36.6 g/m 2 , P = 0.05), and the prevalence of hypertensive retinopathy (51% versus 83%, P = 0.01). The frequency of the combination of all three signs of TOD (microalbuminuria, left ventricular hypertrophy, and hypertensive retinopathy) was higher in nondippers than in dippers (71.4% versus 30%, P = 0.04). We suggest ABPM may provide clinical information to detect patients prone to develop cardiovascular risks and TOD in newly diagnosed mild-to-moderate hypertension. (Int Heart J 2005; 46: 1073-1082

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Section: Discussionsupporting

confidence: 94%

The Frequency of Combined Target Organ Damage and the Beneficial Effect of Ambulatory Blood Pressure Monitoring in Never Treated Mild-to-Moderate Hypertensive Patients

et al. 2005

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“…On the basis of several cross-sectional studies, it seems that "traditional" cardiac risk factors are common in individuals with CKD but that the Framingham risk formula is inadequate in explaining the CVD risk in this population (45)(46)(47), suggesting that other, "nontradional" risks are at play (48,49). There is a higher risk for CVD not just in dialysis patients but also in individuals with earlier stages of kidney dysfunction (50 -54), including microalbuminuria (55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66). It has also been shown that much of the CAD in this population is asymptomatic (67,68).…”

Section: Epidemiology Of Cvd In Ckdmentioning

confidence: 99%

The Unique Character of Cardiovascular Disease in Chronic Kidney Disease and Its Implications for Treatment with Lipid-Lowering Drugs

Nogueira

Weir

2007

Clinical Journal of the American Society of Nephrology

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D uring the past several decades, the advent and refinement of maintenance dialysis and kidney transplantation have essentially eliminated kidney failure per se as a cause of death in developed countries. However, as patients survive many years after the development of renal failure, comorbidities develop, progress, and ultimately cause death in these individuals. Cardiovascular disease (CVD) has ranked prominent among these comorbidities, accounting for nearly half of the deaths (1). All along the continuum of chronic kidney disease (CKD)-from microalbuminuria to ESRD-a higher risk for CVD has been observed (see Epidemiology of CVD in CKD). In fact, individuals with early CKD are more likely to die of CVD than to develop ESRD (2,3). Then, among those who survive to ESRD, the all-cause CVD mortality in patients with ESRD is many-fold higher than in the general population (4). Unfortunately, the reasons for the association of CKD with CVD are not clearly understood, and the role of various clinical interventions in stemming the CVD epidemic are not well defined. Complicating the issue is the potential variation in the pathophysiology and clinical behavior of CVD through the stages of CKD.3-Hydroxyl-3-methylglutaryl CoA reductase inhibitors (statins) and other lipid-lowering drugs (LLD) have been clearly demonstrated to lessen the morbidity and mortality of CVD in the general population; therefore, there is hope that the use of these drugs may likewise help patients with CKD (In addition, it has been theorized that dyslipidemia may contribute to the progression of CKD, such that LLD may prove to slow CKD progression.) Nevertheless, given differences in epidemiology and pathophysiology of CVD in CKD, there are reasons to question whether the cardiovascular benefits of LLD that are observed in the general population will also be realized in the CKD population. It is widely acknowledged that the current medical literature provides insufficient data to guide the use of LLD in the CKD population, in large part because renal insufficiency has been an exclusion criterion for most of the randomized, controlled studies that have addressed this issue. Although consensus-based guidelines on the treatment of dyslipidemias in individuals with CKD and with kidney transplants have been published by the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) Work Groups, the nephrology and cardiology communities recognize the urgent need for high-quality clinical studies on this issue, and this has fueled the publication of subgroup analyses of previous large studies in the general population and the launching of large-scale clinical trials in the CKD population, as summarized in Table 1. To provide the reader with a better appreciation of the important issues that are germane to management of dyslipidemia in CKD, this article (1) briefly summarizes the literature on the benefits of LLD in the general population, (2) demonstrates the limited involvement of individuals with CKD in the studies in the ge...

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“…Not surprisingly, therefore, essential hypertensive patients with microalbuminuria frequently showed either mild fasting hyperglycaemia or a hyperglycaemic response to oral glucose loading. [63][64][65][66][67][68][69][70][71][72] Since a worse glucose tolerance is part of the so-called metabolic syndrome X, 73 slight elevations in UAE were also associated with its typical phenotypes, ie, hyperinsulinaemia, [63][64][65][66][67][68][69][70][71][72]74 insulin resistance, 67,68 high triglycerides and low high-density lipoprotein (HDL), 25,75,76 overweight-obesity 18,77,78 and BP sensitivity to increased sodium intake. 79 Increased concentrations of total and low-density lipoprotein (LDL)-cholesterol sometimes reported in hypertensive patients with microalbuminuria 3 have raised the intriguing possibility of a link between microalbuminuria and atherogenic lipids unrelated to the trait of the syndrome X, but the results of large-scale studies 14,18 seem to contradict that possibility.…”

Section: 4957-59mentioning

confidence: 99%

“…Since the very first descriptions, [115][116][117][118] the association between increased UAE and left ventricular hypertrophy, either by ECG or echographically, has been almost universally confirmed, 3,12,14,49,50,76,[119][120][121][122][123] with a notable exception in patients with stage I hypertension and a high prevalence of white coat hypertension. 24 This discrepant behaviour adds value to the combined determination of the two markers of renal and cardiac involvement to stage risk during the initial phase of hypertension.…”

Section: Left Ventricular Hypertrophymentioning

confidence: 99%

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

et al. 2002

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This paper reviews the existing epidemiological and clinical evidence about the relationships of non-diabetic microalbuminuria with cardiovascular risk factors such as elevated blood pressure (BP), systolic particularly, cardiac hypertrophy, adverse metabolic status, smoking habits, elevated angiotensin II levels, endothelial dysfunction, acute and perhaps subclinical inflammation. Because of that unique property of reflecting the influence of so many clinically relevant parameters, microalbuminuria may legitimately be defined as an integrated marker of cardiovascular risk, an unique profile among the several prognostic predictors available to

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Atherosclerosis profile and microalbuminuria in essential hypertension

Cited by 28 publications

References 25 publications

The Frequency of Combined Target Organ Damage and the Beneficial Effect of Ambulatory Blood Pressure Monitoring in Never Treated Mild-to-Moderate Hypertensive Patients

The Frequency of Combined Target Organ Damage and the Beneficial Effect of Ambulatory Blood Pressure Monitoring in Never Treated Mild-to-Moderate Hypertensive Patients

The Unique Character of Cardiovascular Disease in Chronic Kidney Disease and Its Implications for Treatment with Lipid-Lowering Drugs

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

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