Silent ischemia is more prevalent among hypertensive patients with microalbuminuria and salt sensitivity

Bianchi, Stefano; Bigazzi, Roberto; Amoroso, A; Campese, Vito M.

doi:10.1038/sj.jhh.1001498

Cited by 13 publications

(8 citation statements)

References 59 publications

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“…The prognostic importance of MAU observed in our study is in line with the overall published data [23][24][25][26][27][28]. It confirms the recent analysis of a subcollective of the LIFE study by Ibsen et al [29].…”

Section: Discussionsupporting

confidence: 93%

Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: final results of a prospective long-term study (MARPLE Study)*

Schrader¹,

Lüders²,

Kulschewski³

et al. 2006

Journal of Hypertension

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In non-diabetic hypertensive patients, MAU as well as TPU increases the incidence of cardiovascular events. Normalization of MAU, TPU or macroproteinuria during angiotensin-converting enzyme-inhibitor-based treatment correlates with a reduction of cardiovascular events. Beyond blood pressure control, normalization of MAU and TPU should be considered as a further therapeutic goal. There is a need for further studies to optimize treatment if proteinuria is unresponsive to angiotensin-converting enzyme inhibitors.

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Section: Discussionsupporting

confidence: 93%

Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: final results of a prospective long-term study (MARPLE Study)*

Schrader¹,

Lüders²,

Kulschewski³

et al. 2006

Journal of Hypertension

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“…45–50 The association of SUA with endothelial dysfunction was illustrated in 217 individuals with mild untreated hypertension who underwent measurement of endothelium-dependent brachial artery vasodilation. 25 Compared with participants whose SUA was 3.5 mg/dL or less, endothelium-dependent vasodilation was 33% worse among those with SUA levels of 5.5 mg/dL or more; other studies have found similar associations.…”

Section: Discussionmentioning

confidence: 99%

“…17, 20–22, 24 In addition, higher UAE is associated with sodium sensitivity. 45–48 In 177 healthy volunteers, for example, the prevalence of sodium sensitivity was significantly higher in those whose UAE was 15 to 20 mg/d compared with those whose UAE was 10 mg/d or less (67% vs. 24%). 47 Taken together, these data suggest that higher levels of SUA and UAE indicate the presence of endothelial dysfunction and, as a result, may identify those at higher risk for hypertension when sodium intake is high.…”

Section: Discussionmentioning

confidence: 99%

Association Between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of Developing Hypertension

et al. 2012

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Background In non-hypertensive individuals, a high sodium diet has little acute effect on blood pressure but, for unclear reasons, is associated with hypertension if consumed chronically. We hypothesized that a chronically high sodium intake would be associated with increases in biomarkers of endothelial dysfunction, specifically serum uric acid (SUA) and urine albumin excretion (UAE), and that high sodium intake would be associated with incident hypertension among those with higher SUA and UAE. Methods and Results We prospectively analyzed the associations between sodium intake and the change in SUA (N=4062) and UAE (N=4146) among participants of the PREVEND study who were not taking antihypertensive medications. We also examined the association of sodium intake with the incidence of hypertension (N=5556) among non-hypertensive participants. After adjusting for confounders, each 1 gram higher sodium intake was associated with a 1.2µmol/L increase in SUA (p=0.01) and a 4.6mg/d increase in UAE (p<0.001). The relation between sodium intake and incident hypertension varied according to SUA and UAE. For each 1 gram higher sodium intake, the adjusted hazard ratio for developing hypertension was 0.98 (0.89–1.08) among those in the lowest tertile of SUA, and 1.09 (1.02–1.16) among those in the highest. Corresponding hazard ratios were 0.99 (0.93–1.06) among participants whose UAE was <10mg/d, and 1.18 (1.07–1.29) among those whose UAE was >15mg/d. Conclusions Over time, higher sodium intake is associated with increases in SUA and UAE. Among individuals with higher SUA and urine UAE, a higher sodium intake is an independent risk factor for developing hypertension.

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“…For example, Tsioufis et al [123] showed that such patients exhibited an earlier systolic augmentation of the arterial pressure than normal, reflecting a more impaired arterial elasticity [123]. In addition, patients with hypertension and microalbuminuria have been shown to have an increased incidence of dynamic electrocardiographic changes during exercise [124]. The authors claim that this demonstrates an increased prevalence of silent coronary ischaemia in such patients.…”

Section: Hypertensionmentioning

confidence: 99%

End-organ dysfunction and cardiovascular outcomes: the role of the microcirculation

et al. 2009

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Risk factors for cardiovascular disease mediate their effects by altering the structure and function of wall and endothelial components of arterial blood vessels. A pathological change in the microcirculation plays a pivotal role in promoting end-organ dysfunction that not only predisposes to further organ damage, but also increases the risk for future macrovascular events. The microcirculation is recognized as the site where the earliest manifestations of cardiovascular disease, especially inflammatory responses, occur that may play a pivotal role in driving the atherosclerotic process in conduit vessels. Furthermore, the vast surface area of the endothelium compared with conduit vessels means that the vascular effects of endothelial dysfunction or activation will be most apparent in this section of the vasculature. Current techniques providing indices of vascular health focus on large arteries without providing insight into the structure and function of small vessels. Techniques capable of detecting microvascular damage and monitoring the response to therapeutic interventions, especially in vulnerable target organs of interest, may improve risk stratification and represent a valuable surrogate for future cardiovascular outcome.

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Silent ischemia is more prevalent among hypertensive patients with microalbuminuria and salt sensitivity

Cited by 13 publications

References 59 publications

Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: final results of a prospective long-term study (MARPLE Study)*

Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: final results of a prospective long-term study (MARPLE Study)*

Association Between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of Developing Hypertension

End-organ dysfunction and cardiovascular outcomes: the role of the microcirculation

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