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Microalbuminuria as a marker of preclinical diastolic dysfunction in never-treated essential hypertensives
A M Grandi1, R Santillo, A Bertolini
1Department of Clinical and Biological Sciences, Faculty of Medicine, University of Insubria, Varese, Italy. amgrandi@libero.it
Abstract:
Using 24-h ambulatory blood pressure (BP) monitoring and digitized M-mode echocardiography, we evaluated whether microalbuminuria is related to preclinical left ventricular (LV) diastolic dysfunction in hypertensive patients. We selected 87 never-treated hypertensive patients (mean 24-h BP > 140 and/or > 90 mm Hg); albuminuria was evaluated as mean value of 24-h urinary albumin excretion (UAE) from two 24-h urine collections. Microalbuminuria was found in 28 patients, classified as MA+ (UAE 30 to 300 mg/24 h); 59 patients had normal UAE (< 30 mg/24 h) and were classified as MA-. The MA+ and MA- groups did not differ with regard to age, sex, body mass index, or 24-h heart rate, whereas 24-h, daytime, and nighttime systolic and diastolic BP were significantly higher in MA+ than in MA-. The LV mass index was greater in MA+, as was the prevalence of LV hypertrophy; peak shortening rate of LV diameter, index of systolic function, was normal in all, but was lower in MA+. Peak lengthening rate of LV diameter and peak thinning rate of posterior wall, indices of diastolic function, were lower in MA+ and the prevalence of diastolic dysfunction was higher in MA+. UAE was inversely correlated with both indices of LV diastolic function, also after correction for age, 24-h heart rate, 24-h BP, and LV mass. In conclusion, in never-treated hypertensive patients, microalbuminuria is not only associated with greater myocardial mass, but is also related with preclinical impairment of LV diastolic function. This relation, independent from increased BP or LV mass, strengthens the role of microalbuminuria as an early and reliable marker of preclinical cardiac involvement.
Insights
Microalbuminuria, an early sign of kidney damage, is linked to preclinical heart dysfunction in hypertensive patients. This finding highlights its role as a reliable marker for early cardiac involvement.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Microalbuminuria is an early indicator of kidney damage and is associated with increased cardiovascular risk.
- Preclinical left ventricular (LV) dysfunction may precede symptomatic heart failure in hypertensive individuals.
Purpose of the Study:
- To investigate the relationship between microalbuminuria and preclinical left ventricular (LV) diastolic dysfunction in never-treated hypertensive patients.
- To determine if microalbuminuria is an independent marker of cardiac involvement in hypertension.
Main Methods:
- 24-hour ambulatory blood pressure (BP) monitoring and digitized M-mode echocardiography were used.
- 87 never-treated hypertensive patients were evaluated.
- Urinary albumin excretion (UAE) was measured from two 24-hour urine collections to classify patients as microalbuminuric (MA+) or normoalbuminuric (MA-).
Main Results:
- Microalbuminuria (MA+) was present in 28 patients; 59 had normal UAE (MA-).
- MA+ patients exhibited significantly higher 24-h, daytime, and nighttime BP compared to MA-.
- MA+ group showed increased LV mass index, higher prevalence of LV hypertrophy, and impaired LV diastolic function (lower peak lengthening rate of LV diameter and peak thinning rate of posterior wall).
- UAE was inversely correlated with LV diastolic function indices, independent of age, heart rate, BP, and LV mass.
Conclusions:
- Microalbuminuria is associated with greater myocardial mass and preclinical impairment of LV diastolic function in never-treated hypertensive patients.
- This relationship is independent of elevated BP or LV mass, reinforcing microalbuminuria's role as an early marker of preclinical cardiac involvement.
- Microalbuminuria serves as a reliable indicator of early cardiac changes in hypertensive individuals.