Abstract
We sought in this study to examine the relationship between microalbuminuria and cardiac geometry since a slight increased urinary albumin excretion (UAE) and increased left ventricular (LV) mass have both been identified as predictors of cardiovascular events in hypertensive subjects. For this purpose, microalbuminuria was determined in three non-consecutive 24-h urine samples as UAE of 20–200 mg/24 h in a group of 249 untreated hypertensive subjects. Echocardiographic classification of patients into LV geometric patterns was based on relative wall thickness values and on gender-specific values for LV mass index (LVMI). The group of patients with microalbuminuria (n = 119) was matched for age, sex, body mass index, smoking status and plasma cholesterol level with the group of patients without microalbuminuria (n = 130). Subjects with microalbuminuria had significantly increased LVMI (111 vs 90 g/m2, P < 0.0001), relative wall thickness (0.46 vs 0.41, P < 0.001) and office systolic and diastolic blood pressure (161 vs 148 and 101 vs 97 mmHg, respectively, P < 0.005). For the pooled population, UAE was positively correlated to LVMI (r = 0.46, P < 0.001) and relative wall thickness (r = 0.47, P < 0.001). In the entire population, normal LV geometry, concentric LV remodelling, eccentric and concentric LV hypertrophy was found in 34%, 33%, 12% and 21%, respectively. The prevalence of normal LV geometry was significantly higher in normoalbuminuric compared with microalbumnuric subjects (55 vs 14%, P < 0.001) while the prevalence of concentric LV hypertrophy was significantly higher in microalbuminuric compared with normoalbuminuric subjects (32 vs 5%, P < 0.0001). Multiple regression analysis revealed that concentric LV hypertrophy was significantly associated with increased values of UAE and mean arterial pressure. In conclusion, the higher prevalence of unfavourable LV geometric patterns in hypertensive subjects with microalbuminuria compared with those without microalbuminura, may account for the worse cardiovascular outcomes associated with the presence of an increased UAE in hypertensive subjects.
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References
Jensen JS et al. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease Hypertension 2000 35: 898–903
Borch-Johnsen K et al. Urinary albumin excretion. An independent predictor of ischemic heart disease Arterioscler Thromb Vasc Biol 1999 19: 1992–1997
Mogensen CE . Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes N Engl J Med 1984 310: 356–360
Bigazzi R, Bianchi S, Baldari D, Campese V . Microalbuminuria predicts cardiovascular events and renal insufficiency inpatients with essential hypertension J Hypertens 1998 16: 1325–1333
Pontremoli R et al. Prevalence and clinical correlates of microalbuminuria in essential hypertension. The MAGIC study Hypertension 1997 30: 1135–1143
Cerasola G et al. Microalbuminuria, renal dysfunction, and cardiovascular complication in essential hypertension J Hypertens 1996 14: 915–920
Tsioufis C et al. Microalbuminuria is associated with abnormal thoracic aortic mechanics in essential hypertension Am J Cardiol 2000 86: 797–801
Pedrinelli P . Microalbuminuria in hypertension Nephrol 1996 73: 499–506
Levy D et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study N Engl J Med 1990 322: 1561–1566
Koren MJ et al. Relation of left ventricular mass and geometry to morbidity and mortality in men and women with essential hypertension Ann Intern Med 1991 114: 345–352
The sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure Arch Intern Med 1997 157: 2413–2446
Sahn DJ, De Maria A, Kisslo J, Weyman A . Recommendations regarding quantitation in M-mode echocardiography; results of a survey of echocardiographic measurements Circulation 1978 58: 1072–1083
Devereux RB, Reichek N . Echocardiographic determination of left ventricular mass in man; anatomic validation of the method Circulation 1977 55: 613–618
Krumholz H, Larson M, Levy D . Prognosis of left ventricular geometric patterns in the Framingham heart study J Am Coll Cardiol 1995 25: 879–884
Wachtell K et al. Impact of different partition values on prevalences of left ventricular hypertrophy and concentric geometry in a large hypertensive population. The LIFE study Hypertension 2000 35: 6–12
Ganau A et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension J Am Coll Cardiol 1992 19: 1550–1558
Pontremoli R et al. Left ventricular geometry and function inpatients with essential hypertension and microalbuminuria J Hypertens 1999 17: 993–1000
Devereux RB . Left ventricular geometry, pathophysiology and prognosis J Am Coll Cardiol 1995 25: 885–887
Verdecchia P et al. Adverse prognostic significance of concentric remodeling of the left ventricular in hypertensivepatients with normal left ventricular mass J Am Coll Cardiol 1995 25: 871–887
Jensen JS, Borch-Johnsen K, Jensen G, Rasmussen BF . Microalbuminuria reflects a generalized transvascular albumin leakness in clinically healthy subjects Clin Sci 1995 88: 629–633
Mimran A, Ribstein J, DuGailer G . Is microalbuminuria a marker of early intrarenal vascular dysfunction in essential hypertension Hypertension 1994 23: 1018–1021
Bouthier JD, De Luca N, Safar ME, Simon A Ch . Cardiac hypertrophy and arterial distensibility in essential hypertension Am Heart J 1985 109: 1345–1352
Devereux R, Alderman M . Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events Circulation 1993 88: 1444–1455
Giatras I, Lau J, Levery AS . Effect of angiotensinconverting enzyme inhibitors on progression of nondiabetic renal disease: a meta-analysis of randomized trials Ann Intern Med 1997 127: 337–345
Clausen P et al. Ambulatory blood pressure and urinary albumin excretion in clinically healthy subjects Hypertension 1998 32: 71–77
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Tsioufis, C., Stefanadis, C., Toutouza, M. et al. Microalbuminuria is associated with unfavourable cardiac geometric adaptations in essential hypertensive subjects. J Hum Hypertens 16, 249–254 (2002). https://doi.org/10.1038/sj.jhh.1001379
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DOI: https://doi.org/10.1038/sj.jhh.1001379
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