Association of Microalbuminuria with the Onset of End Organ Damage in Patients with Essential Hypertension

Abstract

Background : Hypertension of long duration especially if not under control leads to damage of retina, kidney, heart and brain. Endothelial dysfunction is considered to be a predominant pathological finding in patients with hypertension. Microalbuminuria , a pathological marker of endothelial dysfunction is frequently elevated in patients with established essential hypertension and is a predictor of a higher risk for cardiovascular disease and renal dysfunction. The presence of microalbuminuria has been shown to correlate with the other cardiovascular risk factors commonly seen in hypertensive patients. This fact indicates that the detection of an increased urinary albumin excretion could be an index of an increased global cardiovascular risk in a given patient. The aim of this study is to evaluate urinary microalbumin in essential hypertensives with and without end organ damage. Methodology: A total of 255 subjects between the age group of 20-55 years of age, from both sexes who were attending the Hypertensive clinic and Master health check up programme in Sri Ramachandra Medical College were enrolled for the study .They were grouped as three-Group I being controls, Group II hypertensives without complications and Group III hpertensives with end organ damage . After overnight fasting , blood and spot urine samples were collected. All the biochemical parameters were estimated by standard methodologies . Urinary microalbumin was determined by immuno turbidimetric method and creatinine by alkaline picrate method . Albumin Creatinine Ratio (ACR) was also calculated. Results : Among the hypertensives with end organ damage 71.42 % had microalbuminuria , 23.21 % , Left Ventricular Hypertrophy ( LVH ) and 4.44 % had Retinopathy. A strong correlation was observed between Systolic blood pressure (SBP ) and microalbumin levels in hypertensives with end organ damage. Highly significant correlation was observed between urinary microalbumin level and creatinine in all the groups. Statistical analysis was done using SPSS Software 19.0. Discussion: 71.42% of the hypertensives with end organ damage had microalbuminuria . A highly significant difference was observed in Urinary creatinine and Albumin Creatinine Ratio (ACR ). It is evidenced that renal damage is an early sign of target organ damage in essential hypertensives. Conclusion: A significant increase in microalbumin levels in essential hypertensives suggests that monitoring the microalbumin levels would be of a great value in assessing the onset of end organ damage.