Dissertation > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Abnormal blood pressure > Hypertension

The Relationship of Microalbuminuria and Cardiovascular Risk Factors in the Patients with Essential Hypertension

Author XuHongLing
Tutor SunJian
School Jilin University
Course Clinical
Keywords hypertension risk factors cardiovascular disease microalbuminuria left ventricular mass index Matrix metalloproteinase-2
CLC R544.1
Type Master's thesis
Year 2008
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These years Microalbuminuria is highly prevelant in the patients with essential hypertension. It is thought to be a very powerful predictor of cardiovascular events and subclinical tagert organs damage. The treatment with anti-hypertension can reduce the level of urinary albumin and reduce the cardiovascular risk. Now the patients examine creatinine, urea nitrogen, urinary routine to evaluate renal damage. We do not pay more attention on microalbuminuria. The study discusses the relationship of microalbuminuria and cardiovascular risk factors in essential hypertension and evaluates the relation of microalbuminuria and left ventricular mass index(LVMI). Micral test is a new method to measure microalbuminuria. It is an easy, convenient way. In our study we discuss wheather Micral test can screen patients with microalbuminuria. Recent years several research have manifested Matrix metalloproteinase-2 (MMP-2) is activated in patients with hypetension, and it relates to extracellular matrix excess deposition in glomerular sclerosis. This study discusses wheather microalbuminuria impacts on MMP-2 in primary hypertension.Objective: To discuss wheather Micral– test can screen the patients with micoralbuminuria. To debate the relationship of microalbuminuria and cardiovascular risk factors, subclinical target organs damage in essential hypertension. To evaluate the correlation of microalbuminuria and MMP-2.Methods: 77 patients with essential hypertension enrolled in our study. They came from in- and out-patients in The Second Hospital of Jilin University from April 2007 to April 2008. Fasting plasma glucose≥6.1mmol/l, dabetes mellitus, heart functionⅡ-Ⅳ, hyperproteinuria, cardiovascular and cerebral vessel deisease were excluded. Micral test and immunoturbidimetry were used to measure urinary albumin. Three nonconsecutive first morning urine samples were collected in Micral test. The result of immunoturbidimetry measurement is as the standard. The result of Micral test≥20mg/l is positive, then speculate sensibility, specificity, and Youden Index. According to the level of urinary albumin,the patients divided into two groups: Microalbuminuia group(MA) and Normal albumiuria group(NA), then compare the level of the duration of essential hypertension, age, Body mass index(BMI), cigarettes history,systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse pressure (PP) , fast plasma glucose,serum lipids, creatinine, uric acid and LVMI in two groups. 23 of 77 patients agreed to measure MMP-2 and pro-MMP-2, then we evaluate the level of MMP-2 and pro-MMP-2 in two groups.Results: The result of immunoturbidimetry measurement was as the standard. The result of Micral test≥20mg/l was positive,the sensibility, specificity,Youden index were 92.8%, 67.3%, and 60.1%, respectively. According to the result of immunoturbidimetry measurement, 49 patients participated in NA group, and 28 patients were in MA group. patients in MA group showed higher BMI, SBP, LVMI as compared to normoalbuminurics, and were 25.25±1.61 vs 23.99±1.49(P=0.001);167.0±18.1 vs 158.6±13.1(P=0.022);116.55±18.10 vs 102.80±17.91(P=0.002), respectively. The patients with microalbuminuria were high prevelance in left ventricular hypertrophy, (42.86% vs 12.24%, P=0.01). There were no difference in sex, duration of the disease, cigarettes history, fast plasma glucose, serum lipids, creatinine, uric acid between two groups. In the group of microalbuminuia, univariate analysis showed that urinary albumin was related to duration, BMI, SBP, DBP, PP, TG, LVMI. The relavent index were 0.331, 0.453, 0.464, 0.353, 0.344, 0.231, 0.567(P﹤0.05), respectively. The multiple regression showed SBP, BMI, and LVMI were major influent factors. 10mmHg increase in SBP entailed 10.3g/l increasing in urinary albumin, 5g/m2 increase in LVMI entailed 5.2mg/d, 2kg/m2 increase in BMI entailed 22.0mg/d. 23 patients consented to measure MMP-2 and pro-MMP-2. 11 patients were included in MA group. MMP-2 and pro-MMP-2 were similar in two groups.Conclusion: Micral-test is a convenient, easy way to screen patients with hypertension and microalbuminuria, roughly, and it is not the standerd way. In patients with EH, Microalbuminuria has a strong correlation with cardiovascular risk factors and subclinical target organs damage. Microalbuminuria is an early predictor of renal damage, extra-renal target organs and cardiovascular damage in patients with essential hypertension. In our study there is not obvious relationship between microalbuminuria and MMP-2 in essential hypertension. But the relationship of microalbuminuria and MMP-2 in essential hypertension will be conferred in the future. Microalbuminuria can be used in identification of prognosis in patients with essential hypertension.

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