Microalbuminuria as a predictor of cardiovascular morbidity in essential hypertensive patients: research study done at tertiary care centre in Western India

Background:Small amount of albumin excretion in urine, termed as microalbuminuria, has been postulated to be an indicator of endothelial dysfunction. This study was done to find the prevalence of microalbuminuria in patients with essential hypertension and to study the association of microalbuminuria with cardiovascular morbidity.Methods:This cross-sectional, observational study was conducted at the Department of Internal Medicine, Medical College and SSG Hospital, Baroda; by selecting 60 first time detected essential hypertensive patients, without any significant past or treatment history, attending Medicine outpatient department (OPD) or admitted in different wards at SSG hospital, for various reasons. A detailed history, clinical examination, basic blood investigation, urine albumin to creatinine ratio, electrocardiography (ECG) and 2D echo were done in all patients.Results:In this study, microalbuminuria was found in 24 (40%) cases with prevalence increasing with increasing age. A higher serum cholesterol, serum low density lipoprotein (LDL) and cholesterol/high density lipoprotein (HDL) ratio; left ventricular hypertrophy (LVH), ST-T changes and bundle branch block on ECG; LVH, hypokinesia and diastolic dysfunction on 2D echo; retinopathy on D fundus examination were all associated with higher microalbumin excretion in urine. Microalbuminuria was independent of age, sex, addiction to smoking, alcohol, BMI and severity/stage of hypertension. Thus, irrespective of existing known cardiovascular risk factors, microalbuminuria was associated with signs of cardiovascular morbidity.Conclusions:As a predictor of systemic vascular dysfunction, microalbuminuria can be used to stratify and prognosticate hypertensive patients at a higher risk of developing further vascular complications and they can be screened early for same.