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[Significance of microproteinuria for early detection of hypertension-induced end organ damage]
R Schmieder1, E Grube, H Rüddel
1Medizinische Universitätsklinik, Bonne-Venusbeg.
Abstract:
To investigate the clinical importance of microproteinuria, we examined the prevalence of microproteinuria and its relation to cardiac structural adaptation in 80 male, middle-aged patients with essential hypertension. Patients with secondary causes of hypertension were ruled out. 14 out of 80 hypertensives (18 percent) were found to have microproteinuria defined as "negative" for urinary protein excretion in the conventional test, but "positive" (above the upper normal limit) in the 24-hour urine samples. Patients with microproteinuria had a similar age and body weight, but a higher systolic and diastolic pressure (161 +/- 14/104 +/- 12 vs 148 +/- 14/97 +/- 9 mmHg, p less than 0.02) and greater creatinine clearance (163 +/- 36 vs 136 +/- 33 ml/min, p less than 0.01) than those with normal protein excretion. Also, hypertensives with microproteinuria had a greater left ventricular mass (241 +/- 57 vs 207 +/- 45 g, p less than 0.05) and greater cross sectional area (22.2 +/- 2.8 vs 20.5 +/- 2.9 cm2, p less than 0.05) evaluated by 2-D guided M-mode echocardiography than the control group. A positive Sokolow-index was more prevalent in patients with microproteinuria than in those without (x2 = 6.2, p less than 0.02). Patients with essential hypertension and microproteinuria (prevalence 21 per cent) were characterized by a higher arterial pressure, by a higher degree of echocardiographic and electrographic evidence of left ventricular hypertrophy. Thus, microproteinuria might serve as a marker for early target organ damage in essential hypertension.
Insights
Microproteinuria, often missed by standard tests, indicates early heart damage in essential hypertension patients. This subtle urinary finding is linked to higher blood pressure and left ventricular hypertrophy.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Context:
- Essential hypertension is a prevalent condition often leading to cardiovascular complications.
- Early detection of target organ damage is crucial for managing hypertension.
- Microproteinuria, defined as low-level protein in urine, is an emerging biomarker.
Purpose:
- To investigate the clinical significance of microproteinuria in middle-aged males with essential hypertension.
- To determine the prevalence of microproteinuria and its association with cardiac structural changes.
- To explore microproteinuria as a potential early indicator of target organ damage.
Summary:
- 18% of hypertensive patients exhibited microproteinuria, undetected by conventional tests but confirmed by 24-hour urine analysis.
- Patients with microproteinuria showed significantly higher systolic and diastolic blood pressure and greater creatinine clearance.
- Echocardiography revealed increased left ventricular mass and cross-sectional area in hypertensive individuals with microproteinuria.
Impact:
- Microproteinuria may serve as an early marker for subclinical cardiac damage in essential hypertension.
- Findings suggest enhanced screening for microproteinuria in hypertensive patients to identify at-risk individuals.
- This research highlights the importance of sensitive urinary protein assessment in cardiovascular risk stratification.