In untreated hypertensive patients, the top quartile of albuminuria was associated with a higher prevalence of left ventricular hypertrophy compared to the lowest quartile (72% vs 25%, P<0.001).
Cross-Sectional (n=211)
Does microalbuminuria correlate with adverse left ventricular geometry, depressed function, and increased carotid wall thickness in untreated hypertensive patients?
Microalbuminuria in untreated hypertensive patients is strongly associated with unfavorable left ventricular geometry, depressed LV function, and early extra-cardiac vascular damage.
Absolute Event Rate: 72% vs 25%
p-value: p=< 0.001
BACKGROUND: Microalbuminuria has recently emerged as a strong, independent predictor of cardiovascular mortality in patients with essential hypertension, yet the pathophysiological mechanisms underlying this association remain to be elucidated. OBJECTIVE: To study the relationship between microalbuminuria and left ventricular geometry and function and extra-cardiac vascular changes in a group of 211 untreated hypertensive patients. METHODS: Albuminuria was evaluated as albumin-to-creatinine ratio in three non-consecutive first morning urine samples. Left ventricular mass index and function were assessed by M-B mode echocardiography and carotid wall thickness by high-resolution ultrasound scan. RESULTS: The prevalences of microalbuminuria and left ventricular hypertrophy were 14 and 47% respectively. Patients in the top quartile of albuminuria showed a higher left ventricular mass index (57 +/- 1.8, 55 +/- 2, 47 +/- 1.4 and 48 +/- 1.6 g/m2.7, respectively; P< 0.0001) as well as a higher prevalence of left ventricular hypertrophy (72, 65, 26 and 25%, respectively; P< 0.001) and especially concentric hypertrophy (56, 47, 17 and 21%, respectively; P< 0.0001) in the four quartiles of albuminuria. Microalbuminuric patients showed depressed left ventricular performance as indicated by a reduced midwall fractional shortening (15.7 +/- 0.3, 15.9 +/- 0.3, 16.7 +/- 0.4 and 16.8 +/- 0.3%, respectively; P< 0.02). Furthermore patients in the top quartile of albuminuria showed increased carotid wall thickness as compared to normoalbuminuric patients (0.78 +/- 0.03, 0.7 +/- 0.04, 0.65 +/- 0.03 and 0.6 +/- 0.03 mm, respectively; P < 0.001). CONCLUSIONS: Hypertensive patients with microalbuminuria show a higher prevalence of unfavourable left ventricular geometric patterns, depressed left ventricular function and early signs of extra-cardiac vascular damage. These findings strengthen the role of microalbuminuria as an indicator of subclinical cardiovascular disease and may account for the worse outcome that is usually associated with increased urinary albumin excretion in essential hypertension.
Pontremoli et al. (1999) conducted a cross-sectional in essential hypertension (n=211). Microalbuminuria (top quartile of albuminuria) vs. Normoalbuminuria (lowest quartile of albuminuria) was evaluated on Prevalence of left ventricular hypertrophy (p=< 0.001). In untreated hypertensive patients, the top quartile of albuminuria was associated with a higher prevalence of left ventricular hypertrophy compared to the lowest quartile (72% vs 25%, P<0.001).