Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients

Abstract

Abstract. Mulè G, Cottone S, Vadalà A, Volpe V, Mezzatesta G, Mongiovì R, Piazza G, Nardi E, Andronico G, Cerasola G (Cattedra di Medicina Interna e Centro Ipertensione, Università di Palermo, Italy). Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients. J Intern Med 2004; 256: 22-29.Objectives. To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness. Design. Cross-sectional study. Setting. Outpatient hypertension clinic. Subjects. Seventy patients with mild-to-moderate essential hypertension, aged 42 AE 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotidfemoral PWV, by means of a computerized method, and AER. Results. Microalbuminuric patients (AER ! 20 lg min À1 ; n ¼ 19), when compared with normoalbuminuric subjects, showed more elevated 24-h BP (136/88 AE 10/10 vs. 128/83 AE 7/ 6 mmHg; P < 0.001 and P ¼ 0.013, for systolic and diastolic BP respectively) and higher values of carotid-femoral PWV (10.4 AE 2 m s À1 vs. 9.2 AE 1.3; P ¼ 0.006). This latter difference remained statistically significant, even after correction by ancova for 24-h systolic and diastolic BP, and body mass index (BMI, P ¼ 0.016). Univariate regression analysis disclosed a tight correlation between AER and carotid-femoral PWV (r ¼ 0.42; P ¼ 0.0003). This association was confirmed in a multiple regression model (b ¼ 0.35; P ¼ 0.009) in which, as independent variables, besides PWV, 24-h BP, age, serum glucose values, smoking status, gender and BMI, were added. Conclusions. Our results seem to confirm that microalbuminuria may represent the early renal manifestation of a widespread vascular dysfunction, and therefore it is an integrated marker of cardiovascular risk.

Differential impact of metabolic syndrome on arterial stiffness and wave reflections: Focus on distinct definitions

“…Similar association has also been established for interleukin-6, a proinflammatory cytokine released by adipocytes [28]. Furthermore, markers of endothelial dysfunction such as plasminogen activator inhibitor-1 (PAI-1) [29] and the proposed (as a marker) microalbuminuria are also related to MS whereas the latter is further associated with arterial stiffness in hypertensive patients [30]. Given that endothelial function regulates arterial stiffness in vivo [31], endothelial dysfunction might serve as a potential mechanism for the association between arterial stiffness and MS.…”

“…A criterion that distinguishes WHO definition from the other definition criteria, and might partially explain this observation, is the presence of microalbuminuria. Although albumin excretion has been related to increased arterial stiffness [30], there is no evidence regarding the association of microalbuminuria with wave reflections in patients with MS.…”

Parallel Deterioration of Albuminuria, Arterial Stiffness and Left Ventricular Mass in Essential Hypertension: Integrating Target Organ Damage

“…Moreover, ACR was the strongest correlate of LVMI predicting 14.3% of its variance. The close link of albuminuria with cardiac hypertensive sequelae is reflected by reports showing that increased ACR is accompanied by LV diastolic dysfunction [18], concentric hypertrophy [1,2,3,8], while the degree of albuminuria may be a predictor of LVH in hypertension [4,5,6,9,18,27]. Moreover, albuminuria reduction parallels risk improvement in the LIFE study and in tandem with LVH proved to be independent and additive prognosticators of cardiovascular events [28].…”

“…Most importantly, levels of albuminuria below the threshold cutoff values are associated with worsening blood pressure (BP), atherosclerotic plaque development and overall cardiovascular mortality [12,13]. Furthermore, hypertensives with augmented albuminuria are accompanied by both increased incidence of LVH and particularly of the concentric type and deterioration of aortic stiffness [8,16,17,18]. In its own right, large artery stiffness significantly determines pressure overload to cardiac muscle and consequently affects LV geometry [19,20].…”

Gender Difference in the Relationship of Albuminuria and Arterial Stiffness in Chinese Adults - a 6.6-Year Follow-Up Longitudinal Study

“…Epidemiological studies have established the association between albuminuria or renal function and arterial stiffness in hypertensive [19,20] or diabetic patients [21,22]. This association was also observed in several cross-sectional studies of the general population [13,[23][24][25], including the TCHS study [14].…”