Microalbuminuria (MAU) and glomerular filtration rate (GFR) are the signs of subclinical kidney damage, independently predict cardiovascular morbidity and mortality. The aim of the study was to investigate the relative role of MAU, cardiac and vascular ultrasonography, carotid-femoral pulse wave velocity (PWV) for the detection of hypertensive target organ damage (TOD) and risk stratification.Design and Method:
In 576 non-diabetic hypertensive patients without established cardiovascular or renal disease (291 male, 53.0 ± 10.1 years, BP 156 ± 13/99 ± 8 mmHg) MAU by albumin/creatinine urine ratio, GFRCKD-EPI, left ventricular mass index (LVMI), carotid intima-media thickness (CIMT), PWV were assessed. Spearman and multiple regression analysis were performed. P < 0.05 was considered statistically significant.Results:
Prevalence of subclinical kidney damage, echo left ventricular hypertrophy (LVH), CIMT >0.9 mm and/or plaque, PVW >10 m/s was 37.5, 46.3, 23.6 and 25.7%, respectively. Different signs of TOD only partly cluster in the same group of patients. The odds ratio (OR) of a microalbuminuric patient having LVH and/or vascular damage is 19.5 (95% CI 5–82); the OR of a patient with LVH having MAU and/or vascular damage is 7.25 (95% CI 3–16); the OR of a patient with PVW >10 m/s having MAU and/or LVH and/or carotid thickening or plaque is 3 (95% CI 1–4); the OR of a patient with CIMT >0.9 mm and/or plaque having MAU and/or LVH and/or PVW >12 m/s is 2 (95% CI 1–4). There was positive correlation between albumin/creatinine urine ratio and LVMI (r = 0.46, p < 0.001), CIMT (r = 0.38, p < 0.001), PWV (r = 0.34, p < 0.001).Conclusions:
Microalbuminuria was the most integrated sign of TOD in uncomplicated hypertensive patients. Due availability, low cost and high predictive value combined assessment of GFR and MAU should be the first step in detection of TOD for cardiovascular risk assessment. Cardiac and vascular ultrasonography for assessment of LVMI and CIMT should be performed in patients without signs of subclinical kidney damage.