Microalbuminuria as a predictor of cardiovascular morbidity in essential hypertensive patients: research study done at tertiary care centre in Western India
DOI:
https://doi.org/10.18203/2349-3933.ijam20212857Keywords:
Microalbuminuria, Essential hypertension, EchocardiographyAbstract
Background:Small amount of albumin excretion in urine, termed as microalbuminuria, has been postulated to be an indicator of endothelial dysfunction. This study was done to find the prevalence of microalbuminuria in patients with essential hypertension and to study the association of microalbuminuria with cardiovascular morbidity.
Methods:This cross-sectional, observational study was conducted at the Department of Internal Medicine, Medical College and SSG Hospital, Baroda; by selecting 60 first time detected essential hypertensive patients, without any significant past or treatment history, attending Medicine outpatient department (OPD) or admitted in different wards at SSG hospital, for various reasons. A detailed history, clinical examination, basic blood investigation, urine albumin to creatinine ratio, electrocardiography (ECG) and 2D echo were done in all patients.
Results:In this study, microalbuminuria was found in 24 (40%) cases with prevalence increasing with increasing age. A higher serum cholesterol, serum low density lipoprotein (LDL) and cholesterol/high density lipoprotein (HDL) ratio; left ventricular hypertrophy (LVH), ST-T changes and bundle branch block on ECG; LVH, hypokinesia and diastolic dysfunction on 2D echo; retinopathy on D fundus examination were all associated with higher microalbumin excretion in urine. Microalbuminuria was independent of age, sex, addiction to smoking, alcohol, BMI and severity/stage of hypertension. Thus, irrespective of existing known cardiovascular risk factors, microalbuminuria was associated with signs of cardiovascular morbidity.
Conclusions:As a predictor of systemic vascular dysfunction, microalbuminuria can be used to stratify and prognosticate hypertensive patients at a higher risk of developing further vascular complications and they can be screened early for same.
References
Delacroix S, Chokka RG. Hypertension: Pathophysiology and Treatment. J Neurol Neurophysiol. 2014;5(6):1-8.
Khandelwal B. Microalbuminuria as an overrated indicator of target organ damage in hypertension: a hospital based cross section. Int J Res Med Sci. 2014;2(3):881.
A Global Brief on Hypertension A Global Brief on Hyper Tension. 2013. Available at: www.who.int. Accessed on 20 February 2021.
Gupta S, Gudapati R, Gaurav K, Bhise M. Emerging risk factors for cardiovascular diseases: Indian context. Indian J Endocrinol Metab. 2013;17(5):806-14.
De Zeeuw D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol. 2006;17(8):2100-5.
Summerson JH, Bell RA, Konen JC. Racial differences in the prevalence of microalbuminuria in hypertension. Am J Kidney Dis. 1995;26(4):577-9.
Crippa G. Microalbuminuria in essential hypertension. J Human Hypertens. 2002;16(1):74-7.
Rodicio JL, Campo C, Ruilope LM. Microalbuminuria in essential hypertension. Kidney Int. 1998;54:51-4.
Maggon RR, Malik R, Jain N, Isser HS. Study of the prevalence of microalbuminuria in patients of essential hypertension and its correlation with left ventricular hypertrophy and carotid artery intima-media thickness. J Clin Prevent Cardiol. 2018;7(1):411.
Kumar AH, Dinesh Raghav E, RESEARCH Or. A Study of Microalbuminuria in Patients with Essential Hypertension. Int J Contemp Med Res. 2016;3.
Aggarwal HK, Jain D, Mor S, Yadav RK, Jain P. Prevalence and Clinical Correlates of Microalbuminuria in Patients with Essential Hypertension - A Tertiary Care Center Cross Sectional Study. J Assoc Physicians India. 2018;66(5):30-4.
Jacobs DR Jr, Murtaugh MA, Steffes M, Yu X, Roseman J, Goetz FC. Gender- and race-specific determination of albumin excretion rate using albumin-to-creatinine ratio in single, untimed urine specimens: the Coronary Artery Risk Development in Young Adults Study. Am J Epidemiol. 2002;155(12):1114-9.
Hitha B, Pappachan JM, Pillai HB, Sujathan P, Ramakrishna CD, Jayaprakash K, Raihanathul Misiriya KJ. Microalbuminuria in patients with essential hypertension and its relationship to target organ damage: an Indian experience. Saudi J Kidney Dis Transpl. 2008;19(3):411-9.
Lee SH, Kim DH, Kim YH. Relationship Between Dyslipidemia and Albuminuria in Hypertensive Adults: A Nationwide Population-Based Study. Medicine (Baltimore). 2016;95(16):e3224.
Maharjan BR, Bhandary S, Sunuwar L, Shrestha A, Ranjitkar N. Association of hypertension with microalbuminuria and lipid profile in the local population of Patan. Nepal Med Coll J. 2012;14(2):157-62.
Campese VM, Bianchi S, Bigazzi R. Association between hyperlipidemia and microalbuminuria in essential hypertension. Kidney Int Suppl. 1999;71:10-3.
Sabharwal RK, Singh P, Arora MM, Ambade V. Incidence of microalbuminuria in hypertensive patients. 2008;23.
Radhakrishnan S, Alphonse F, Marudhaiveeran G. Prevalence of microalbuminuria among patients with essential hypertension. Trop J Med Res. 2014;17(2):76.
