Martins Dina, Pimenta Gonçalo, Constantino Liliana, Santos Tiago, Rosendo Inês, Matias Catarina, Miranda Paula, Francisco Maria Prazeres, Neto Maria Glória, Santiago Luiz Miguel
Trabalho realizado no Centro de Saúde de Eiras, Administração Regional de Saúde do Centro.
Rev Port Cardiol. 2010 May;29(5):751-64.
Microalbuminuria, as determined by the urinary albumin to creatinine (AC) ratio, is a marker of target organ damage (TOD) in hypertensive patients. Pulse pressure (PP) predicts arterial elasticity and the ankle-brachial index (ABI) is a marker of cardiovascular morbidity. TOD reduction should be achieved through improvements in these indices.
To determine whether ABI, calculated as the ratio between mean PP in the upper and lower limbs, is associated with a reduction in renal damage, as measured by the AC ratio.
This was a prospective interventional study based on an intention-to-treat analysis in an opportunity sample of patients treated by three specialists in family medicine, with three-monthly follow-up over a total of six months. Blood pressure was measured in arms and ankles, and PP was calculated and used to determine right and left ABI and mean overall ABI. The AC ratio was determined by urine dipstick test. Descriptive and inferential statistical analysis was performed.
A sample of 75 patients were studied (42.4% women), of whom(42.4% women), of whom 27.6% were diabetic, 46.7% overweight/obese and 49.3% dyslipidemic. overweight/obese and 49 dyslipidemic. There were statistical differences for right ABI (as determined by PP) and for mean overall ABI (as determined by mean PP in lower and upper limbs). Bivariate correlation analysis showed that in the group with improved PP between the first and the third observations, n=23 (40%), there was a statistically significant reduction in AC ratio (r = -0.924, two-tailed p < 0.001); the opposite was observed in the group with reduced PP, in which the AC ratio increased.
ABI determined by systolic blood pressure is an excellent predictor of hemodynamic alterations. Increased ABI, based on PP, was accompanied by improved urinary AC ratio. These results are in line with the international literature.
An improvement in urinary AC ratio--a predictor of TOD--is observed when an improvement in the ankle PP/brachial PP ratio is achieved.
通过尿白蛋白与肌酐（AC）比值测定的微量白蛋白尿是高血压患者靶器官损害（TOD）的一个标志物。脉压（PP）可预测动脉弹性，踝臂指数（ABI）是心血管疾病发病率的一个标志物。应通过改善这些指标来实现TOD的降低。
确定以上下肢平均PP比值计算的ABI是否与AC比值所衡量的肾损害降低相关。
这是一项前瞻性干预研究，基于意向性分析，对由三名家庭医学专家治疗的机会样本患者进行研究，共随访六个月，每三个月随访一次。测量手臂和脚踝的血压，计算PP并用于确定左右ABI和总体平均ABI。通过尿试纸条试验测定AC比值。进行描述性和推断性统计分析。
研究了75例患者的样本（42.4%为女性），其中27.6%患有糖尿病，46.7%超重/肥胖，49.3%血脂异常。右ABI（由PP确定）和总体平均ABI（由下肢和上肢的平均PP确定）存在统计学差异。双变量相关性分析表明，在第一次和第三次观察之间PP改善的组中，n = 23（40%），AC比值有统计学显著降低（r = -0.924，双侧p < 0.001）；在PP降低的组中观察到相反情况，其中AC比值增加。
由收缩压确定的ABI是血流动力学改变的一个优秀预测指标。基于PP的ABI增加伴随着尿AC比值的改善。这些结果与国际文献一致。
当踝部PP/臂部PP比值得到改善时，可观察到作为TOD预测指标的尿AC比值有所改善。
