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Urinary albumin excretion and atherosclerosis in essential hypertension
R Pedrinelli1, K Lindpaintner, G Dell'Omo
1I Clinica Medica, Università di Pisa, Italy.
Insights
Vascular dysfunction in essential hypertension may increase urinary albumin excretion, independent of blood pressure. Atherosclerosis correlates with higher albumin levels, suggesting vascular status impacts kidney health in hypertensive patients.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- Increased urinary albumin excretion is common in essential hypertension, linked to blood pressure.
- Generalized vascular dysfunction in advanced atherosclerosis may independently affect urinary albumin excretion.
Purpose of the Study:
- To evaluate if vascular status independently influences urinary albumin excretion in essential hypertension.
- To compare patients with essential hypertension and peripheral vascular disease to uncomplicated hypertension and normotensive controls.
Main Methods:
- Assessed blood pressure, carotid artery thickness (ultrasound), cardiac mass, forearm vascular resistance, metabolic parameters, and ACE genotype.
- Compared data between untreated essential hypertension with atherosclerosis (n=11), uncomplicated hypertension (n=11), and normotensive controls (n=11).
Main Results:
- Urinary albumin excretion and carotid thickness were higher in hypertensive patients with atherosclerosis.
- A significant positive correlation was found between carotid thickness and urinary albumin excretion.
- Elevated systolic blood pressure, fasting insulin, and triacylglycerol levels correlated with urinary albumin, but differences persisted after adjustment.
Conclusions:
- Vascular status, indicated by carotid thickness, may independently influence urinary albumin excretion in essential hypertension.
- Confirms systolic blood pressure as a determinant of elevated urinary albumin excretion.
Abstract:
1. Increased urinary albumin excretion is common in patients with essential hypertension and is at least to some extent correlated with prevailing blood pressure levels. However, the generalized vascular dysfunction present in advanced atherosclerotic disease may independently influence this parameter. 2. To evaluate this possibility, we assessed blood pressure, ultrasonographic carotid thickness, cardiac mass, minimum forearm vascular resistances, metabolic parameters and the angiotensin-converting enzyme genotype in patients with untreated essential hypertension and atherosclerotic peripheral vascular disease (n = 11). The results were compared with similar data obtained in matched groups of patients with uncomplicated hypertension and with normotensive control subjects (n = 11 per group). 3. Urinary albumin excretion was higher in hypertensive patients with atherosclerosis than in those without complications; carotid thickness was higher in atherosclerotic patients and a positive, statistically significant correlation existed between this parameter and urinary albumin excretion. In the same patient group, systolic blood pressure, fasting insulin and triacylglycerol levels were elevated and correlated with urinary albumin levels. However, differences in urinary albumin excretion persisted after taking into account the influence of those parameters by analysis of covariance. The distribution of angiotensin-converting enzyme genotype patterns and values of cardiac mass and minimum forearm vascular resistances did not differ significantly among the experimental groups. 4. The data suggest that vascular status may influence urinary albumin excretion in patients with essential hypertension, while confirming the importance of systolic blood pressure levels as a determinant of the raised urinary albumin excretion.