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Microalbuminuria and hypertensive retinopathy among newly diagnosed nondiabetic hypertensive adult Nigerians
OA Busari, OG Opadijo, AB Omotoso
Nigerian Journal of Clinical Practice , 2011,
Abstract: Objective: Microalbuminuria (MA) is a marker of vascular damage and has prognostic implications in hypertension. The objective of this study was to determine if the presence of MA increases the risk of hypertensive retinal damage in nondiabetic adult Nigerians with hypertension. Materials and Methods: A total of 96 consecutive newly diagnosed hypertensive patients attending the outpatient clinic and who consented and met the criteria for the study were recruited. There was also the same number of age- and sex-matched normotensive controls. Results: MA was present in 31 (32.3%) of the patients and 6 (6.3%) of the controls. The mean (±SD) ages of patients with and without MA were 52.5 ± 11.9 years and 48.3 ± 13.0 years, respectively. The diastolic blood pressure (P = 0.03) and mean arterial pressure (P = 0.01) were statistically higher in hypertensive patients with MA than in their counterparts without it. Patients with MA were more likely to have hypertensive retinopathy (HRP) than patients without it (71% vs 37%, P = 0.001). Advanced HRP, i.e., Grades III - IV, was more common in patients with MA than in those without it (22.6% vs 1.5%). Conclusion: This study shows a high prevalence of HRP in Nigerian hypertensives with MA.
Prevalence and risk factors of microalbuminuria in Thai nondiabetic hypertensive patients  [cached]
Pongsathorn Gojaseni,Angkana Phaopha,Worawon Chailimpamontree,et al
Vascular Health and Risk Management , 2010,
Abstract: Pongsathorn Gojaseni1, Angkana Phaopha1, Worawon Chailimpamontree1, Thaweepong Pajareya1, Anutra Chittinandana21Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand; 2Department of Education, Directorate of Medical Services, Royal Thai Air Force, Bangkok, ThailandPurpose: To assess the prevalence and risk factors of microalbuminuria in nondiabetic hypertensive patients in Thailand.Patients and methods: A cross-sectional study was performed during January to December 2007 at outpatients departments of Bhumibol Adulyadej hospital. Nondiabetic hypertensive patients without a history of pre-existing kidney diseases participated in this study. A questionnaire was used for collecting information on demographics, lifestyle, and family history of cardiovascular and kidney disease. Spot morning urine samples were collected for albuminuria estimation. Albuminuria thresholds were evaluated and defined using albumin-creatinine ratio (ACR).Results: A total of 559 hypertensive patients (283 males, 276 females), aged 58.0 ± 11.6 years were enrolled in this study. Microalbuminuria (ACR 17 to 299 mg/g in males and 25 to 299 mg/g in females) was found in 93 cases (16.6%) [15.0% 18.2%]. The independent determinants of elevated urinary albumin excretion in a multiple logistic regression model were; body mass index ≥30 (odds ratio (OR) = 2.24, 95% confidence intervals (CI): 1.33–3.76) and dihydropyridine calcium channel blockers (DCCB) use (OR = 1.92, 95% CI: 1.22 3.02).Conclusion: In Thai nondiabetic hypertensive patients, microalbuminuria was not uncommon. Obesity and use of dihydropyridine calcium channel blocker were found to be the important predictors. Prognostic value of the occurrence of microalbuminuria in this population remains to be determined in prospective cohort studies.Keywords: microalbuminuria, hypertension, obesity, calcium channel blocker, metabolic syndrome
Prevalence and risk factors of microalbuminuria in Thai nondiabetic hypertensive patients
Pongsathorn Gojaseni, Angkana Phaopha, Worawon Chailimpamontree, et al
Vascular Health and Risk Management , 2010, DOI: http://dx.doi.org/10.2147/VHRM.S9739
Abstract: evalence and risk factors of microalbuminuria in Thai nondiabetic hypertensive patients Original Research (3620) Total Article Views Authors: Pongsathorn Gojaseni, Angkana Phaopha, Worawon Chailimpamontree, et al Published Date March 2010 Volume 2010:6 Pages 157 - 165 DOI: http://dx.doi.org/10.2147/VHRM.S9739 Pongsathorn Gojaseni1, Angkana Phaopha1, Worawon Chailimpamontree1, Thaweepong Pajareya1, Anutra Chittinandana2 1Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand; 2Department of Education, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand Purpose: To assess the prevalence and risk factors of microalbuminuria in nondiabetic hypertensive patients in Thailand. Patients and methods: A cross-sectional study was performed during January to December 2007 at outpatients departments of Bhumibol Adulyadej hospital. Nondiabetic hypertensive patients without a history of pre-existing kidney diseases participated in this study. A questionnaire was used for collecting information on demographics, lifestyle, and family history of cardiovascular and kidney disease. Spot morning urine samples were collected for albuminuria estimation. Albuminuria thresholds were evaluated and defined using albumin-creatinine ratio (ACR). Results: A total of 559 hypertensive patients (283 males, 276 females), aged 58.0 ± 11.6 years were enrolled in this study. Microalbuminuria (ACR 17 to 299 mg/g in males and 25 to 299 mg/g in females) was found in 93 cases (16.6%) [15.0% 18.2%]. The independent determinants of elevated urinary albumin excretion in a multiple logistic regression model were; body mass index ≥30 (odds ratio (OR) = 2.24, 95% confidence intervals (CI): 1.33–3.76) and dihydropyridine calcium channel blockers (DCCB) use (OR = 1.92, 95% CI: 1.22 3.02). Conclusion: In Thai nondiabetic hypertensive patients, microalbuminuria was not uncommon. Obesity and use of dihydropyridine calcium channel blocker were found to be the important predictors. Prognostic value of the occurrence of microalbuminuria in this population remains to be determined in prospective cohort studies.
Microalbuminuria In Nondiabetic Acute Ischaemic Stroke - An Indian Perspective
Mathur PC,Punckar Prashant,Muralidharan Rajesh
Annals of Indian Academy of Neurology , 2005,
Abstract: To investigate the incidence, relationship to risk factors and severity of stroke with microalbuminuria (MA) in nondiabetic acute ischaemic stroke in Indians. Methods : We studied 50 patients of nondiabetic acute ischaemic stroke within 24 hours of onset of symptoms for MA by dipstick urinalysis. Results: The incidence of MA was 68% (34 patients). Of all the traditional risk factors for stroke-age, male gender, hypertension, dyslipidaemia, smoking, obesity - only age of patients (>60 years) showed a positive correlation with the presence of MA (-<0.05). Patients with MA had more severe neurological deficit (Scandinavian Stroke Scale {SSS} < 30 vs. > 30; mean+S.D=24.3+8.66 vs. 30.3+10.3, p<0.03) and more severe depressed levels of consciousness {SSS < 4 vs. SSS > 6, 82.35 vs. 17.6, p<0.05). Conclusion: The incidence of MA in Indians with nondiabetic acute ischaemic stroke is significantly higher than that of western populations. Patients with MA in the first 24 hours after the onset of stroke have more severe neurological deficit and depressed levels of consciousness than patients without MA.
Relationship between microalbuminuria and cardiac structural changes in mild hypertensive patients
Plavnik, F.L.;Silva, M.A.M.R.T.;Kohlmann, N.E.B.;Kohlmann Jr., O.;Ribeiro, A.B.;Zanella, M.T.;
Brazilian Journal of Medical and Biological Research , 2002, DOI: 10.1590/S0100-879X2002000700006
Abstract: the aim of this study was to determine the relationship between urinary albumin excretion (uae), cardiac structural changes upon echocardiography and 24-h ambulatory blood pressure (abpm) levels. twenty mild hypertensive patients (mean age 56.8 ± 9.6 years) were evaluated. after 2 weeks of a washout period of all antihypertensive drugs, all patients underwent an echocardiographic evaluation, a 24-h abpm and an overnight urine collection. systolic and diastolic blood pressure during 24-h abpm was 145 ± 14/91 ± 10 mmhg (daytime) and 130 ± 14/76 ± 8 mmhg (nighttime), respectively. seven (35%) patients presented uae 315 μg/min, and for the whole group, the geometric mean value for uae was 10.2 x/÷ 3.86 μg/min. cardiac measurements showed mean values of interventricular septum thickness (ivs) of 11 ± 2.3 mm, left ventricular posterior wall thickness (pwt) of 10 ± 2.0 mm, left ventricular mass (lvm) of 165 ± 52 g, and left ventricular mass index (lvmi) of 99 ± 31 g/m2. a forward stepwise regression model indicated that blood pressure levels did not influence uae. significant correlations were observed between uae and cardiac structural parameters such as ivs (r = 0.71, p<0.001), pwt (r = 0.64, p<0.005), lvm (r = 0.65, p<0.005) and lvmi (r = 0.57, p<0.01). compared with normoalbuminuric patients, those who had microalbuminuria presented higher values of all cardiac parameters measured. the predictive positive and negative values of uae 315 μg/min for the presence of geometric cardiac abnormalities were 75 and 91.6%. these data indicate that microalbuminuria in essential hypertension represents an early marker of cardiac structural damage.
Relationship between microalbuminuria and cardiac structural changes in mild hypertensive patients  [cached]
Plavnik F.L.,Silva M.A.M.R.T.,Kohlmann N.E.B.,Kohlmann Jr. O.
Brazilian Journal of Medical and Biological Research , 2002,
Abstract: The aim of this study was to determine the relationship between urinary albumin excretion (UAE), cardiac structural changes upon echocardiography and 24-h ambulatory blood pressure (ABPM) levels. Twenty mild hypertensive patients (mean age 56.8 ± 9.6 years) were evaluated. After 2 weeks of a washout period of all antihypertensive drugs, all patients underwent an echocardiographic evaluation, a 24-h ABPM and an overnight urine collection. Systolic and diastolic blood pressure during 24-h ABPM was 145 ± 14/91 ± 10 mmHg (daytime) and 130 ± 14/76 ± 8 mmHg (nighttime), respectively. Seven (35%) patients presented UAE > or = 15 μg/min, and for the whole group, the geometric mean value for UAE was 10.2 x/÷ 3.86 μg/min. Cardiac measurements showed mean values of interventricular septum thickness (IVS) of 11 ± 2.3 mm, left ventricular posterior wall thickness (PWT) of 10 ± 2.0 mm, left ventricular mass (LVM) of 165 ± 52 g, and left ventricular mass index (LVMI) of 99 ± 31 g/m2. A forward stepwise regression model indicated that blood pressure levels did not influence UAE. Significant correlations were observed between UAE and cardiac structural parameters such as IVS (r = 0.71, P<0.001), PWT (r = 0.64, P<0.005), LVM (r = 0.65, P<0.005) and LVMI (r = 0.57, P<0.01). Compared with normoalbuminuric patients, those who had microalbuminuria presented higher values of all cardiac parameters measured. The predictive positive and negative values of UAE > or = 15 μg/min for the presence of geometric cardiac abnormalities were 75 and 91.6%. These data indicate that microalbuminuria in essential hypertension represents an early marker of cardiac structural damage.
Connecting Cerebral White Matter Lesions and Hypertensive Target Organ Damage  [PDF]
Cristina Sierra,Alfons López-Soto,Antonio Coca
Journal of Aging Research , 2011, DOI: 10.4061/2011/438978
Abstract: Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems and various organs, especially the brain, kidney, and retina. The brain is an early target of organ damage due to high blood pressure, which is the major modifiable risk factor for stroke and small vessel disease. Stroke is the second leading cause of death and the number one cause of disability worldwide and over 80% of strokes occur in the elderly. Preclinical hypertensive lesions in most target organs are clearly identified: left ventricular hypertrophy for the heart, microalbuminuria for the kidney, fundus abnormalities for the eye, and intima-media thickness and pulse wave velocity for the vessels. However, early hypertensive brain damage is not fully studied due to difficulties in access and the expense of techniques. After age, hypertension is the most-important risk factor for cerebral white matter lesions, which are an important prognostic factor for stroke, cognitive impairment, dementia, and death. Studies have shown an association between white matter lesions and a number of extracranial systems affected by high BP and also suggest that correct antihypertensive treatment could slow white matter lesions progression. There is strong evidence that cerebral white matter lesions in hypertensive patients should be considered a silent early marker of brain damage. 1. Introduction Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems, and various organs, especially the brain, kidney, and retina [1, 2]. Early detection of hypertensive target organ damage is important for more-successful prevention of cardiovascular diseases and to improve outcomes [1, 2]. The brain is an early target for organ damage due to high blood pressure (BP) [1, 2], which is the major modifiable risk factor in men and women for ischemic and hemorrhagic stroke [3], as well as small vessel disease [1, 2, 4] predisposing to lacunar infarction, white matter lesions (WML), and cerebral microbleeds, which are frequently silent [1, 2, 5]. Stroke is the second leading cause of death and the leading cause of disability worldwide [6]. For each decade of life after the age of 55 years, the stroke rate doubles in both men and women, and >80% of strokes occur in people aged ≥65 years [6]. Because of the aging population, the burden of stroke will increase greatly in forthcoming years. The increased vulnerability of elderly people to stroke is associated with changes in the aging brain and also with a higher prevalence of well-documented risk factors for stroke such as
Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study
Lopes, Antonio Alberto;Andrade, Jadelson;Noblat, Antonio Carlos Beisl;Silveira, Marco Antonio;
Arquivos Brasileiros de Cardiologia , 2001, DOI: 10.1590/S0066-782X2001000800004
Abstract: objective: to use published hypertension optimal treatment (hot) study data to evaluate changes in cardiovascular mortality in nondiabetic hypertensive patients according to the degree of reduction in their diastolic blood pressure. methods: in the hot study, 18,700 patients from various centers were allocated at random to groups having different objectives of for diastolic blood pressure: £90 (n=6264); £85 (n=6264); £80mmhg (n=6262). felodipine was the basic drug used. other antihypertensive drugs were administered in a sequential manner, aiming at the objectives of diastolic blood pressure reduction. results: the group of nondiabetic hypertensive subjects with diastolic pressure£80mmhg had a cardiovascular mortality ratio of 4.1/1000 patients/year, 35.5% higher than the group with diastolic pressure £90mmhg (cardiovascular mortality ratio, 3.1/1000 patients/year). in contrast, diabetic patients allocated to the diastolic pressure objective group of £80mmhg had a 66.7% reduction in cardiovascular mortality (3.7/1000 patients/year) when compared with the diastolic pressure group of £90mmhg (cardiovascular mortality ratio, 11.1/1000 patients/year). conclusion: the results indicate that in hypertensive diabetic patients reduction in diastolic blood pressure to levels £80mmhg decreases the risk of fatal cardiovascular events. it remains necessary to define the level of diastolic blood pressure £90mmhg at which maximal reduction in cardiovascular mortality is obtained for nondiabetics.
Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study  [cached]
Lopes Antonio Alberto,Andrade Jadelson,Noblat Antonio Carlos Beisl,Silveira Marco Antonio
Arquivos Brasileiros de Cardiologia , 2001,
Abstract: OBJECTIVE: To use published Hypertension Optimal Treatment (HOT) Study data to evaluate changes in cardiovascular mortality in nondiabetic hypertensive patients according to the degree of reduction in their diastolic blood pressure. METHODS: In the HOT Study, 18,700 patients from various centers were allocated at random to groups having different objectives of for diastolic blood pressure: <=90 (n=6264); <=85 (n=6264); <=80mmHg (n=6262). Felodipine was the basic drug used. Other antihypertensive drugs were administered in a sequential manner, aiming at the objectives of diastolic blood pressure reduction. RESULTS: The group of nondiabetic hypertensive subjects with diastolic pressure<=80mmHg had a cardiovascular mortality ratio of 4.1/1000 patients/year, 35.5% higher than the group with diastolic pressure <=90mmHg (cardiovascular mortality ratio, 3.1/1000 patients/year). In contrast, diabetic patients allocated to the diastolic pressure objective group of <=80mmHg had a 66.7% reduction in cardiovascular mortality (3.7/1000 patients/year) when compared with the diastolic pressure group of <=90mmHg (cardiovascular mortality ratio, 11.1/1000 patients/year). CONCLUSION: The results indicate that in hypertensive diabetic patients reduction in diastolic blood pressure to levels <=80mmHg decreases the risk of fatal cardiovascular events. It remains necessary to define the level of diastolic blood pressure <=90mmHg at which maximal reduction in cardiovascular mortality is obtained for nondiabetics.
Microalbuminuria and its relations with serum lipid abnormalities in adult Nigerians with newly diagnosed hypertension
Busari O,Opadijo O,Olarewaju O
Annals of African Medicine , 2010,
Abstract: Background: Microalbuminuria (MA) has been associated with increased risk of adverse cardiovascular events in nondiabetic hypertensive patients. This may be partly due to increased serum lipid abnormalities in these patients. The objective was to evaluate the association between MA and serum lipid abnormalities in nondiabetic adult Nigerians with hypertension. Materials and Methods: A prospective study which recruited 96 consecutive newly diagnosed adult Nigerian hypertensive met the study criteria. These patients were compared with the same number of age- and sex-matched healthy normotensive individuals. Results: 52 (54.2%) and 44 (45.8%) of patients were males and females, respectively. Mean ± SD ages were 51.2 ± 10.1 and 48.2 ± 8.8 years for male and female patients, respectively. Microalbuminuria was more than five times more prevalent in the patients than in the controls. The means ± SD serum total cholesterol (5.0 ± 0.56 vs. 4.05 ± 0.50 mmol/L, P = 0.04) and low-density lipoprotein cholesterol (3.99 ± 0.49 vs. 2.84 ± 0.58 mmol/L, P = 0.001) were significantly higher, while the mean ± SD for high-density lipoprotein cholesterol was (0.91 ± 0.16 vs. 1.04 ± 0.13 mmol/L, P = 0.03) significantly lower in microalbuminuric patients than in non-microalbuminuric patients. Conclusion: This study has shown that adult nondiabetic Nigerians with MA are significantly more likely to have dyslipidemia than patients without MA. Hence, this subset of hypertensive patients constitutes a high risk group. Screening for MA, and early recognition and prompt treatment of serum lipid abnormalities in these patients may reduce the risk of adverse cardiovascular events.
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