Microalbuminuria as a marker of preclinical diastolic dysfunction in never-treated essential hypertensives

Abstract

Using 24-h ambulatory blood pressure (BP) monitoring and digitized M-mode echocardiography, we evaluated whether microalbuminuria is related to preclinical left ventricular (LV) diastolic dysfunction in hypertensive patients. We selected 87 never-treated hypertensive patients (mean 24-h BP > 140 and/or > 90 mm Hg); albuminuria was evaluated as mean value of 24-h urinary albumin excretion (UAE) from two 24-h urine collections. Microalbuminuria was found in 28 patients, classified as MA+ (UAE 30 to 300 mg/24 h); 59 patients had normal UAE (< 30 mg/24 h) and were classified as MA-. The MA+ and MA- groups did not differ with regard to age, sex, body mass index, or 24-h heart rate, whereas 24-h, daytime, and nighttime systolic and diastolic BP were significantly higher in MA+ than in MA-. The LV mass index was greater in MA+, as was the prevalence of LV hypertrophy; peak shortening rate of LV diameter, index of systolic function, was normal in all, but was lower in MA+. Peak lengthening rate of LV diameter and peak thinning rate of posterior wall, indices of diastolic function, were lower in MA+ and the prevalence of diastolic dysfunction was higher in MA+. UAE was inversely correlated with both indices of LV diastolic function, also after correction for age, 24-h heart rate, 24-h BP, and LV mass. In conclusion, in never-treated hypertensive patients, microalbuminuria is not only associated with greater myocardial mass, but is also related with preclinical impairment of LV diastolic function. This relation, independent from increased BP or LV mass, strengthens the role of microalbuminuria as an early and reliable marker of preclinical cardiac involvement.

Red Cell Distribution Width and Inappropriateness of Left Ventricular Mass in Patients with Untreated Essential Hypertension

“…Microalbuminuria was defined as that urine albumin-creatinine ratio (ACR) is between 30 μg /mg and 300 μg/mg [ 19 ]. Urine albumin concentration was measured by immunoturbidimetric method [ 20 ]. In addition, fasting blood glucose level, creatinine level and fasting serum lipid status including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, and high-sensitive C-reactive protein levels were also recorded.…”

Preclinical Cardiorenal Interrelationships in Essential Hypertension

“…Particularly, the presence of ≥3 cardiovascular comorbidities nearly doubled the risk of MA, while patients with LVH had the highest prevalence of MA (68%). Additionally, Tsioufis et al [27 ]have demonstrated an association between MA and unfavorable cardiac geometric adaptations in essential hypertensive subjects.Furthermore, MA has been shown to be a marker of preclinical diastolic dysfunction in never-treated essential hypertensives [28]. Likewise, it has also been shown than LVH is highly prevalent in hypertensive patients with CKD stages 2-5.…”

Prevalence of Albuminuria and Cardiovascular Risk Profile in a Referred Cohort of Patients with Type 2 Diabetes: An Asian Perspective

“…A meta-analysis of these studies showed that the presence of MA doubled the risk of CV morbidity or mortality. 3 Besides its role in diabetic nephropathy, MA is also associated with essential hypertension, 4 ischemic heart disease, 5 atherosclerosis, 6 acute stroke, 7 and diastolic dysfunction 8 and is an independent powerful risk factor for fatal and nonfatal vascular events and all-cause mortality in subjects without diabetes. 9,10 In fact, Ibsen et al 11 showed that a reduction in urinary albumin excretion was associated with a reduction in CV events in hypertensive patients treated with blockade of the renin-angiotensin system (RAS).…”