Relation of microalbuminuria to the left ventricular mass and cardiovascular risk factors in hypertension and type 2 diabetes mellitus

ABSTRACT

The presence of microalbuminuria was associated with a relative risk of all cause mortality 2-8 times higher than that in similar individuals without microalbuminuria and the cardiovascular mortality and morbidity was 2-4 times higher than in persons without microalbuminuria and left ventricular hypertrophy [LVH] represents a risk factor of cardiovascular disease, independent of systolic blood pressure, as well as of age, smoking and cholesterol. We aimed in this study to find out relation of microalbuminuria to left ventricular mass [LVM] and cardiovascular risk factors among hypertensive patients with or without type 2 diabetes mellitus. This study included 10 healthy volunteers [group I] as a control group with age ranged from 20-60 years and 40 hypertensive patients with or without type 2 diabetes mellitus and were classified into; Group II included 10 patients with isolated hypertension with age ranged 35-74 years and duration of hypertension ranged from 1- 15 years, 6 patients with positive microalbuminuria. Group III included 10 hypertensive patients with type 2 diabetes mellitus without microalbuminuria with age ranged from 35-62 years and duration of both hypertension and D. M. ranged from 1-15 and 1-10 years respectively. Group IV Included 10 hypertensive patients with type 2 diabetes mellitus associated with microalbuminuria with age ranged from 36-70 years and duration of hypertension ranged from 1-10 years and duration of D. M. ranged from 2-17 years. All individuals were subjected to the following-Complete history taking and thorough clinical examination, routine laboratory tests [CBC, urine analysis, renal function tests, LFT, FBS and PPBS, Lipogram and detection of microalbuminuria], resting 12 leads electrocardiography and plain chest X-ray, body weight, height and body surface area [BSA] and finally echocardiographic study. The mean values of left ventricular mass index [LVMI] in different groups were 74.8 +/- 21.1, 131.9 +/- 43.2, 118.5 +/- 48.2 and 121.0 +/- 26.9 respectively with a highly significant difference [F = 4.72 and P <0.01] between different groups. LVMI was significantly higher in groups II, III, and IV in comparison to group I [P <0.05], also there was a significantly higher value in group II in comparison to both group III and II [P <0.05], there was no significant difference between group III and IV. The mean values of microalbuminuria [UAE] in different groups were 8.4 +/- 4.0, 73.3 +/- 32.2, 8.4 +/- 4.0 and 150.0 +/- 52.7 mg/L respectively with a highly significant difference [F = 35.88 and P <0.01] between the different groups. Microalbuminuria was significantly higher in both group II and IV in comparison to both group I and III [P <0.05], also there was significantly higher value in group IV in comparison to group 11 [P <0.05], there was no significant difference between group I and III. There was a highly significant positive correlation between microalbuminuria and systolic blood pressure[r=0.678, P < 0.01], there was no significant correlation between microalbuminuria and diastolic blood pressure [r=0.133], Also there was a significant positive correlation between microalbuminuria and both FBS [r-0.201, P < 0.05] and PPBS [r=0.218, P < 0.05]. In correlating microalbuminuria and the lipid profile, we found a significant positive correlation between microalbuminuria and total cholesterol [r=0.443, P < 0.05], a significant negative correlation between micaoalbuminuria and HDL-C [r=-.319, P < 0.05], while there was no significant correlation between microalbuminuria and both triglyceride and LDL-C [r= 0.179 and 0.134 respectively]. There was a significant correlation between LVMI and microalbuminuria in the patients with positive microalbuminuria [r = 0.462, P <0.05]. We concluded that the presence of microalbuminuria related closely to the LVMI in both hypertensive and hypertensive diabetic patients, and its presence associated with various potentially reversible risk factors including systolic hypertension, altered lipid profile and poor glucose control. So, increased attention has been given to the role of microalbuminuria as a cardiovascular risk indicator, particularly in patients with diabetes and hypertension