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Microalbuminuria is a late event in patients with hypertension: Do we need a lower threshold?

Mohamed Abdel Kader Abdel Wahab1, Mohamed Mohamed Saad1, Khaled Abdel Ghany Baraka1

  • 1Department of Cardiology, El Minya, Egypt.

Journal of the Saudi Heart Association
|January 28, 2017
PubMed
Abstract

Insights

Vascular damage markers like increased intima-media thickness and arterial stiffness appear before microalbuminuria (MA) in hypertensive patients. These findings suggest a lower threshold for defining MA may improve early cardiovascular risk detection.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Hypertension Research

Background:

  • Microalbuminuria (MA) is a recognized marker of vascular damage.
  • Emerging evidence suggests increased cardiovascular risk at albuminuria levels below current MA definitions.

Purpose of the Study:

  • To investigate early cardiovascular alterations preceding the onset of MA in hypertensive individuals.
  • To assess subclinical vascular changes in hypertensive patients with varying left ventricular (LV) geometry.

Main Methods:

  • Assessed LV mass index, ambulatory arterial stiffness index, flow-mediated dilatation, and carotid intima-media thickness (IMT) in 150 hypertensive and 60 normotensive individuals.
  • Categorized participants into normotensive with normal LV geometry, hypertensive with normal LV geometry, and hypertensive with abnormal LV geometry.
  • Measured urinary albumin/creatinine ratio (UACR) from spot urine samples.

Main Results:

  • Hypertensive patients (Group II) showed increased arterial stiffness and IMT, and decreased flow-mediated dilatation compared to normotensive individuals (Group I), without differing MA levels.
  • These vascular changes were more pronounced in hypertensive patients with abnormal LV geometry (Group III).
  • MA significantly increased in Group III, and receiver operating characteristic analysis indicated MA (cut-off 19.25 mg/g) predicted increased IMT and abnormal LV geometry.

Conclusions:

  • Subclinical vascular changes, including increased IMT, reduced vasodilator function, and heightened arterial stiffness, precede MA and alterations in LV geometry.
  • These findings support the utility of a lower threshold for defining MA to identify early vascular damage.
  • Early detection of vascular changes before MA may allow for timely intervention in hypertensive patients.
Keywords:
EndotheliumHypertensionMicroalbuminuria

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