Relations of serum aldosterone and microalbuminuria to left ventricular hypertrophy in patients with essential hypertension

Left ventricular hypertrophy [LVH] is an independent risk factor for cardiovascular morbidity and mortality in hypertensive patients. The identification of risk factors for the initiation of LVH in patients with hypertension [HTN] is important including microalbuminunuria [MAU] and hyperaldosteronism. Evaluation of the relationship of MAU and plasma aldosterone to blood pressure [BP] and LVH in patients with essential HTN. Thirty male patients with essential HTN and 15 healthy subjects as a control group were subjected to thorough clinical examination, transthoracic echocardiography, lipid profile, serum potassium, and serum aldosterone estimation. MAU was evaluated with dipstick Micral-II Test of fasting midstream morning urine on two successive days. Left ventricular mass index [LVMI] was calculated and values >134gm/m[2] were considered as LVH. Patients with LVMI >134 gm/m[2] had higher serum aldosterone, BMI, Interventricular septal thickness [IVST], Posterior wall thickness [PWT] and Relative wall thickness [RWT]. Serum aldosterone was significantly higher among the test hypertensive group and was positively correlated correlated with LVMI, RWT, PWT, IVST, LVM and negatively correlated with LV diastolic dimensions. MAU was positively correlated with systolic BP, Pulse pressure, BMI and LVMI and a strong relationship between MAU and serum aldosterone was detected. Aldosterone is an important contributor to the development of LVH and hypertensive nephropathy and strong relation between microalbuminuria and aldosterone is detected. The Value of selective aldosterone blockers in preventing target organ damage [TOD] awaits further investigation

Usefulness of carotid intima-media thickness and brachial artery flow mediated dilatation in diabetic patients with suspected coronary artery disease

Objective: flow associated dilatation [FXD%] and intima media thickness are established markers of early atherosclerosis. This study aimed to compare the ability of the non-invasive measurements FAD% and intima media thickness to predict coronary artery disease in asymptomatic diabetic males

Methods: B-mode ultrasonography was used to assess both intima media thickness in the common carotid artery and endothelial function in the brachial artery in 64 non-insulin dependent diabetic male patients asymptomatic for coronary artery disease. They were divided into two groups, Group A comprise patients with positive stress test, and group B patients with negative stress test. Brachial artery diameter was measured at rest, during reactive hyperemia, and after sublingual administration of nitroglycerin

Results: patients with positive exercise stress test had reduced FAD% compared with those with negative exercise stress test [4.4 +/- 0.67 v 5.8 +/- 1.1 5%. p<0.001], whereas intima media thick-ness tended to be increased in patients with positive exercise stress test but not statistically significant [1.1 +/- 0.16 v 0.96 +/- 0.0lmm, p > 0.05]. There was a negative correlation between FAD% and intima media thickness [r =-0.498, p <0.001]. Receiver operating character-istic analysis showed that FAD% > 4.6% predicted coronary artery disease with a sensitivity of 0.70 and a specificity of 0.87

Conclusions: brachial artery FMD may become a useful tool for screening diabetic male patients with suspected CALI while determination of increased intima media thickness is not useful in discrimina between presence or absence of coronary artery disease