Relationship between low-grade albuminuria and unfavourable cardiac geometric adaptations and left ventricular diastolic dysfunction in essential hypertensive patients / 中国医师进修杂志

ABSTRACT

Objective To investigate the relationship between low-grade albuminuria and unfavourable cardiac geometric adaptations and left ventricular diastolic dysfunction in non-treated essential hypertensive(EH ) patients. Methods Three hundred and one patients of EH were divided into three groups acording to morning urine albumin concentration ( MU AC ) normoalbuminuria (NAU) group ( 107 cases,MUAC ＜ 10 mg/L) ;low-gradealbuminuria (LGAU) group ( 127 cases, MUAC 10-30 mg/L); microalbuminuria (MAU) group (67 cases, MUAC ＞ 30 mg/L). The blood pressure,body height and weight was measured for all the patients. The serum creatinine (SCr),blood urea nitrogen (BUN), uric acid (UA),fasting plasma glucose (FBG), plasma glucose 2 hours after oral glucose load (2hPG), total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were detected by automatic biochemical analyzer.Echocardiogram exarmination was performed to detect left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic posterior wall thickness (LVPWT) and interventricular septum thickness at end-diastole (IVST). Color Doppler ultrasound was used to measure indicators of left ventricular diastolic function, including peak E velocity of mitral diastolic flow (E) and peak A velocity of mitral diastolic flow ( A ), calculated E/A, measured the deceleration time of peak E ( DT ), and isovolumic relaxation time (IV RT ).Left ventricular mass index (LVMI) and relative wall thickness(RWT) were calculated by formula, and LVMI,RWT,left ventricular configuration diastolic dysfunction was compared. Results The level of MUAC had positive relationship with LVMI (r = 0.43 ,P ＜ 0.01 ). Compared with that in NAU group, IVST, LVPWT,RWT, LVMI increased (P ＜ 0.01 ), the ratio of left ventricular normal configuration decreased (P ＜ 0.01 ), the incidence of concentric reconstitution, concentric hypertrophy increased (P ＜ 0.05 ), A increased (P ＜ 0.05 ),and E/A decreased (P ＜ 0.01 ) in LGAU group. The total incidence of left ventricular diastolic dysfunction was 28.6%(86/301 ),12.1%(13/107),33.9%(43/127) and 44.8%(30/67)in NAU group,LGAU group and MAU group. The incidencerates of left ventricular diastolic dysfunction in LGAU group and MAU group were higher than that in NAU group (P ＜ 0.01 ). Conclusion LGAU is positively related to incidence of unfavourable cardiac geometric adaptations and left ventricular diastolic dysfunction in EH patients.