Microalbuminuria in Essential Hypertension and Its Relationship to Target Organ Damage

BACKGROUNDHypertension is a disease that increases the risk for development of cerebral, cardiac and renal events.Many patients with essential hypertension may present with overt or subclinical target organ damage at the time of their initial diagnosis.The cost effectiveness of BP reduction using drug therapy is greater in the presence of target organ abnormalities and/ or co-morbidities.Assessment of subclinical target organ damage has become the key element in evaluating hypertensive patients.Microalbuminuria is one of the earliest indications of kidney injury in patients with diabetes mellitus and hypertension and is associated with high incidence of cardiovascular morbidity.A renewed interest in microalbuminuria and essential hypertension occurred when several studies pointed out the importance of microalbuminuria as a risk factor for renal and cardiovascular disease in patients with diabetes mellitus and hypertension.It possibly reflects a state of increased renal endothelial permeability and is an early marker of diffuse endothelial dysfunction.Aims and Objectives-1.To study the relative frequency of microalbuminuria in essential individuals suffering from essential hypertension.2. To study the relationship between microalbuminuria, and age of the patient, duration of hypertension, levels of blood pressure and other coronary risk factors.3. To look for evidence of target organ damage.4. To study the relation between microalbuminuria and the indices of target organ damage. MATERIALS AND METHODSA total of 150 patients admitted in Government Medical College, Kottayam, Kerala with essential hypertension were studied.Detailed history regarding onset and duration of hypertension, drug treatment and symptoms of target organ involvement was taken.Detailed clinical examination and necessary investigations were done.Microalbuminuria was estimated by immunoturbidimetry method on the urine sample collected over 24 hours. RESULTSThe prevalence of microalbuminuria was 26.7%.Distribution of the end organ complications in patients with microalbuminuria were LVH in 59.1%, Stroke in 52.4% and Retinopathy in 34.7%.This difference was found to be highly significant.Microalbuminuria was found to be more prevalent in patients with longer duration, greater severity of hypertension and dyslipidaemia. CONCLUSIONControl of risk factors amenable to prevention (control of hypertension, weight and lipid levels) may have a favourable effect in preventing, delaying and lessening microalbuminuria.Microalbuminuria in hypertensive subjects seems to be a very important test to be considered in the evaluation of target organ damage.