The American Heart Hospital Journal
hypertension was 5.6 %. This proportion is lower than previously reported results; however, the study was conducted when the majority of patients were receiving antihypertensive drug treatment, therefore the results were even more difficult to interpret. In the study by Jalal et al., the prevalence of microalbuminuria in patients with hypertension was found to be 37.5 %.14
In another large
clinical trial that involved patients with mild and moderate essential hypertension, a 6.1 % prevalence of microalbuminuria was reported.15
Agewall et al. also
reported a prevalence of microalbuminuria of around 23 % in a population of patients with hypertension who were selected as being at high risk for cardiovascular disease.16
Variations in the prevalence of microalbuminuria between 10 % and 40 %17–21
reported in other studies are likely due
to differences in the selection criteria, the techniques used for the detection of microalbuminuria, and in some cases, to the small number of patients studied.22
These variations
may also be due to differences in age, race, severity of hypertension, and coexistent renal disease in these study populations. In our study, no relationship was found between the indices of LV systolic function and microalbuminuria. This result is similar to the findings of Pontremoli et al., who found no relationship between microalbuminuria and LV relative wall thickness.23 However, this differs slightly from the findings of Wachtell et al., who revealed that microalbuminuria was approximately two- to threefold higher in patients with hypertension with eccentric or concentric LVH, and minimally elevated in the group with concentric LV remodeling compared with patients with normal LV geometry.3
Our study suggested that neither LVH nor concentric LV geometry were associated with high UACR. In addition, our study did not support the efficacy of UACR measurement to stratify risk of LV systolic or diastolic dysfunction in patients with essential hypertension.
1. Liao Y, Cooper RS, Durazo-Arvizu R, et al., Prediction of mortality risk by different methods of indexation for left ventricular mass, J Am Coll Cardiol, 1997;29:648–50.
2. Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, et al., Urinary albumin excretion. An independent predictor of ischemic heart disease, Arterioscler Thromb Vasc Biol, 1999;19:1992–7.
3. Wachtell K, et al. Are urinary albumin excretion and left ventricular hypertrophy both independent predictors of overall mortality in patients with electrocardiographic left ventricular hypertrophy?, J Am Coll Cardiol, 2002;39:237A.
4. Jensen JS, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B, Atherosclerotic risk factors are increased in clinically healthy subjects with microalbuminuria, Atherosclerosis, 1995;112:245–52.
5. Cirillo M, Senigalliesi L, Laurenzi M, et al., Microalbuminuria in nondiabetic adults: relation of blood pressure, body mass index, plasma cholesterol levels, and smoking: the Gubbio Population Study, Arch Intern Med, 1998;158:1933–9.
6. Jensen JS, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B,
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Figure 2: Correlation Between Early Diastolic Peak Velocity to Early Mitral Annulus Velocity (E/E’) Ratio and Urine Albumin to Creatinine Ratio (UACR) (R=-0.025, p=0.794)
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E/E’ E/E’
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Although a weak association was found between microalbuminuria and the E/A ratio index as a LV diastolic filling marker, this association was not multivariately proved when adjusted for gender and age. In fact, based on measuring the partial low sensitivity and specificity of the UACR parameter for predicting LVH, it seems that the presence of microalbuminuria in patients with essential hypertension could not discriminate LVH and normal LV geometry in our population. However, further studies with larger sample sizes are strongly recommended. n
Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects, Clin Sci (Colch), 1995;88:629–33.
7. Jensen JS, Renal and systemic transvascular albumin leakage in severe atherosclerosis, Arterioscler Thromb Vasc Biol, 1995;15:1324–9.
8. Wachtell K, Palmieri V, Olsen MH, et al., Urine albumin/creatinine ratio and echocardiographic left ventricular structure and function in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. Losartan Intervention for Endpoint Reduction, Am Heart J, 2002;143:319–26.
9. Jensen JS, Borch-Johnsen K, Jensen G, et al., Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects, Clin Sci (Colch), 1995;88:629–33.
10. Jensen JS, Feldt-Rasmussen B, Strandgaard S, et al., Arterial hypertension, microalbuminuria, and risk of ischemic heart disease, Hypertension, 2000;35:898–903.
11. Jensen JS, Renal and systemic transvascular albumin leakage in severe atherosclerosis, Arterioscler Thromb Vasc Biol, 1995;15:1324–9.
Winter 2011 Urine Albumin to Creatinine Ratio and Echocardiographic Left Ventricular Structure and Function in Patients with Hypertension 93
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