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Microalbuminuria, insulin sensitivity and haemostatic factors in non-diabetic treated hypertensive men. Risk Factor
S Agewall1, B Fagerberg, S Attvall
1Department of Medicine, Sahlgrenska University Hospital, Göteborg University, Sweden.
Insights
Microalbuminuria in hypertensive men is linked to insulin resistance, but obesity confounds this association. Further analysis revealed connections with fibrinogen and von Willebrand factor, though these were not independent findings.
Area of Science:
- Nephrology
- Cardiology
- Metabolic Syndrome
Background:
- Microalbuminuria is an early marker of kidney damage and cardiovascular risk.
- Hypertension is a major risk factor for cardiovascular disease and kidney dysfunction.
- Insulin resistance is increasingly recognized as a contributor to cardiovascular and renal pathology.
Purpose of the Study:
- To investigate the association between microalbuminuria and insulin resistance in non-diabetic, treated hypertensive men.
- To explore the relationship between microalbuminuria and markers of endothelial function, thrombogenesis, and fibrinolysis.
- To identify potential confounding factors, such as obesity, in these associations.
Main Methods:
- A cross-sectional study was conducted with 92 treated hypertensive men (aged 57-77 years).
- Participants were selected based on elevated cholesterol or smoking status, excluding those with diabetes or significant albuminuria.
- Key measurements included overnight urinary albumin excretion, insulin-mediated glucose disposal (hyperinsulinaemic euglycaemic clamp), oral glucose tolerance tests, and markers of coagulation and fibrinolysis.
Main Results:
- Microalbuminuric patients exhibited higher blood glucose levels during oral glucose tolerance tests and elevated plasma fibrinogen compared to normoalbuminuric individuals.
- A subgroup analysis indicated lower insulin sensitivity in microalbuminuric patients, with an inverse correlation between insulin sensitivity and albuminuria (r = -0.37, P = 0.028).
- Univariate analyses showed associations between albuminuria and blood glucose, creatinine, body-mass index, systolic blood pressure, fibrinogen, von Willebrand factor, and cholesterol; however, only body-mass index remained independently related in multiple regression analysis.
Conclusions:
- Microalbuminuria is associated with insulin resistance in this cohort of hypertensive men, but obesity acts as a significant confounding factor.
- While univariate analyses suggested links between microalbuminuria and fibrinogen and von Willebrand factor, these relationships were not independently confirmed.
- The findings highlight the complex interplay between metabolic factors, vascular health, and early kidney dysfunction in hypertensive individuals.
Objective:
To examine whether microalbuminuria in non-diabetic, treated hypertensive men is associated with insulin resistance and measures of endothelial function, thrombogenesis and fibrinolysis.
Design:
Cross-sectional study.
Setting:
Outpatient clinic in city hospital.
Patients:
Ninety-two treated hypertensive men, aged 57-77 years, either with a serum cholesterol of > or = 6.5 mmol L-1 or smokers, or both. Patients with diabetes mellitus or overnight urinary albumin excretion of > 100 mg 12 h-1 were excluded.
Main Outcome Measures:
Overnight urinary albumin excretion, insulin-mediated glucose disposal (hyperinsulinaemic euglycaemic clamp), blood glucose and plasma insulin during oral glucose tolerance test, fibrinogen, von Willebrand factor and plasminogen activator inhibitor activity.
Results:
Microalbuminuric patients had increased blood glucose concentrations during the oral glucose tolerance test and higher plasma fibrinogen levels compared with the normoalbuminuric patients. In a randomly selected subgroup (n = 36), insulin-mediated glucose disposal was lower in microalbuminuric than in normoalbuminuric patients, and an inverse relationship between insulin sensitivity and albuminuria (r = -0.37; P = 0.028) was found. This relationship was not significant after adjustment for body-mass index (P = 0.098). In the univariate analyses including all patients, albuminuria was associated with blood glucose, serum creatinine, body-mass index, systolic blood pressure, fibrinogen, von Willebrand factor and cholesterol (negatively). In a multiple regression analysis, only the body-mass index was independently related to urinary albumin excretion.
Conclusions:
Microalbuminuria was associated with insulin resistance but obesity was a confounding factor. Relationships between microalbuminuria and fibrinogen as well as von Willebrand factor were found, but only in univariate analysis.