Microalbuminuria is associated with an enhanced risk for cardiovascular (CV) events. The prevalence of microalbuminuria and its prognostic impact in patients with essential hypertension followed by general practitioners (GP's) remains poorly investigated. This is an observational, prospective study performed by 13 GP's in the area of Azienda Sanitaria Locale Napoli 3 Sud aimed to assess the prevalence and prognostic relevance of microalbuminuria in essential hypertension.Design and method:
Patients with essential hypertension and recent determination of microalbuminuria were invited to participate to the study and followed for 3 years. As primary end point was considered the occurrence of major CV events.Results:
From 1024 patients enrolled from January 2009 to March 2010, 804 completed the 3-year follow-up period. Patients were categorized in two groups according the absence (n = 523, 65%) or presence (n = 281, 35%) of microalbuminuria. The prevalence of diabetes (42% vs 12%, p < 0.001), hypercholesterolemia (30% vs 19%, p < 0.001) and metabolic syndrome (42% vs 11%, p < 0.001) was higher in patients with microalbuminuria compared with those without microalbuminuria. At last follow-up visit, no difference of blood pressure (BP) were found between the two groups. In particular, systolic and diastolic BP were 129 ± 6 mmHg and 80 ± 7 mmHg and 131 ± 9 mmHg (p = 0.491) and 81 ± 8 mmHg, (p = 0.197) in patients without and with microalbuminuria, respectively. During the follow-up, there were recorded 41 CV events (1.69 events/100 patient-years). There were detected 26 and 15 CV events in patients without and with microalbuminuria (p = 0.316). The presence of microalbuminuria was not associated with increased risk of CV events (adjusted HR = 1.32; 95% C.I. 0.290–4.340, p = 0.097). When the analysis was restricted to the patients with previous CV event, microalbuminuria (adjusted HR = 2.18; 95% C.I. 0.42–2.43, p = 0.031), with age, metabolic syndrome, diabetes and cigarette smoking resulted to be a predictor of CV events.Conclusions:
Presence of microalbuminuria in patients with uncomplicated hypertension is not associated with increased risks for CV events On the contrary, in patients with previous CV events, microalbuminuria is a predictor of recurrent events. Thus, the assessment of microalbuminuria should be considered an useful tool in secondary prevention.