Falqui Valeria, Viazzi Francesca, Leoncini Giovanna, Ratto Elena, Parodi Angelica, Conti Novella, Tomolillo Cinzia, Deferrari Giacomo, Pontremoli Roberto
Department of Internal Medicine and Cardionephrology, Azienda Universitaria Ospedale San Martino, University of Genoa, Genoa - Italy.
J Nephrol. 2007 Nov-Dec;20 Suppl 12:S63-7.
Target organ damage (TOD) is an often reversible subclinical condition that may precede major cardiovascular events in primary hypertensive patients. Furthermore, TOD has been shown to be a complex, multifactorial process which does not depend on blood pressure (BP) reduction alone. We therefore investigated the relationship between BP load, vascular permeability and the occurrence of TOD.
Thirty-seven never-treated, nondiabetic hypertensive patients were enrolled. Albuminuria was measured as the albumin to creatinine ratio (ACR), left ventricular mass index (LVMI) was assessed by echocardiography, systemic vascular permeability was evaluated by transcapillary escape rate of albumin (TERalb), and BP was measured by means of 24-hour ambulatory BP monitoring.
Patients with microalbuminuria showed higher levels of body mass index (BMI) (p<0.034), 24-hour systolic BP levels (p<0.001), left ventricular mass index (LVMI) (p=0.003) and capillary permeability to albumin (p<0.005), as compared with normoalbuminurics. Increased BP load and vascular permeability were associated with higher LVMI (p=0.012) and with an increased risk of having microalbuminuria and/or left ventricular hypertrophy (Chi square=17.4; p<0.001). Logistic regression analysis showed that the risk of having at least 1 sign of TOD was 10-fold higher in patients with TERalb above the median, and almost 5-fold higher for each 10 mm Hg increase in systolic blood pressure.
Abnormal vascular permeability and increased BP load are potentially modifiable risk factors that are independently associated with the development of subclinical cardiac and renal damage.
靶器官损害（TOD）是一种通常可逆的亚临床状态，可能先于原发性高血压患者发生重大心血管事件。此外，TOD已被证明是一个复杂的多因素过程，不仅仅取决于血压（BP）的降低。因此，我们研究了血压负荷、血管通透性与TOD发生之间的关系。
纳入37例未经治疗的非糖尿病高血压患者。以白蛋白与肌酐比值（ACR）测量蛋白尿，通过超声心动图评估左心室质量指数（LVMI），通过白蛋白的毛细血管逃逸率（TERalb）评估全身血管通透性，并通过24小时动态血压监测测量血压。
与尿白蛋白正常者相比，微量白蛋白尿患者的体重指数（BMI）（p<0.034）、24小时收缩压水平（p<0.001）、左心室质量指数（LVMI）（p=0.003）和白蛋白毛细血管通透性（p<0.005）更高。血压负荷增加和血管通透性增加与更高的LVMI相关（p=0.012），并与微量白蛋白尿和/或左心室肥厚的风险增加相关（卡方=17.4；p<0.001）。逻辑回归分析显示，TERalb高于中位数的患者出现至少1种TOD体征的风险高10倍，收缩压每升高10 mmHg风险几乎高5倍。
血管通透性异常和血压负荷增加是潜在可改变的危险因素，与亚临床心脏和肾脏损害的发生独立相关。
