Guerra Federico, Mancinelli Lucia, Buglioni Alessia, Pierini Valentina, Rappelli Alessandro, Dessì-Fulgheri Paolo, Sarzani Riccardo
Department of Internal Medicine and Cardiovascular Diseases, Hypertension Excellence Centre of the European Society of Hypertension, University Hospital Ospedali Riuniti, Marche Polytechnic University, Ancona, Italy.
High Blood Press Cardiovasc Prev. 2011 Dec 1;18(4):195-201. doi: 10.2165/11593650-000000000-00000.
Left ventricular hypertrophy (LVH) and microalbuminuria are common in hypertensive patients and are often associated with metabolic syndrome (MetS). However, it is not clear whether MetS could modify the association between cardiac and renal damage.
The aim of this study was to assess if the relationship of albumin/creatinine ratio (ACR) and left ventricular mass (LVM) could be independent from MetS in hypertensive overweight/obese patients.
180 essential hypertensive and overweight/obese (body mass index [BMI] ≥25 kg/m(2)) patients referred to our Hypertension Centre from January 2006 to April 2009 because of blood pressure (BP) control-related problems were studied. Exclusion criteria were scarce adherence to antihypertensive drug therapy as investigated by the Morisky Medical Adherence Scale (MMAS), heart failure (New York Heart Association III or IV or left ventricular ejection fraction [LVEF] <50%), liver failure, cancer or other systemic severe diseases. MetS was defined according to the National Cholesterol Education Program (USA) Adult Treatment Panel III classification as modified by the American Heart Association. ACR was obtained from first morning urine specimens. Left ventricular dimensions, mass and ejection fraction, were measured by echocardiography following the American Society of Echocardiography recommendations.
Patients with microalbuminuria had a 6-fold higher risk for LVH/h(2.7) and 2-fold higher risk for LVH/body surface area (BSA). Univariate linear regression analysis showed a positive relationship between ACR and LVM, expressed both as LVM/h(2.7) or LVM/BSA, as well as a direct correlation between logACR and interventricular diameters and ejection fraction. Regression models including logACR, estimated glomerular filtration rate, BMI, age, hypertension duration, smoking and MetS (as a single variable as well as each single component), showed that only logACR, BMI, hypertension duration and systolic blood pressure (SBP) were independently associated with LVM/h(2.7).
Along with BP and BMI, albuminuria measured in a morning urine sample as ACR is a valuable low-cost index of cardiac organ damage and increased cardiovascular risk in hypertensive patients independently by MetS. On the other hand, MetS is not an independent risk factor for cardiac damage because it does not seem to add anything more than the sum of each of its components (especially SBP and adiposity indexed by BMI) to the relationship between cardiac and renal subclinical organ damage.
左心室肥厚（LVH）和微量白蛋白尿在高血压患者中很常见，且常与代谢综合征（MetS）相关。然而，尚不清楚MetS是否会改变心脏和肾脏损害之间的关联。
本研究旨在评估高血压超重/肥胖患者中，白蛋白/肌酐比值（ACR）与左心室质量（LVM）之间的关系是否独立于MetS。
研究对象为2006年1月至2009年4月因血压（BP）控制相关问题转诊至我们高血压中心的180例原发性高血压超重/肥胖（体重指数[BMI]≥25 kg/m²）患者。排除标准包括通过Morisky药物依从性量表（MMAS）调查发现的对抗高血压药物治疗依从性差、心力衰竭（纽约心脏协会III或IV级或左心室射血分数[LVEF]<50%）、肝功能衰竭、癌症或其他全身性严重疾病。MetS根据美国国家胆固醇教育计划（美国）成人治疗小组III分类并经美国心脏协会修改后定义。ACR取自晨尿标本。按照美国超声心动图学会的建议，通过超声心动图测量左心室尺寸、质量和射血分数。
微量白蛋白尿患者发生LVH/h²的风险高6倍，发生LVH/体表面积（BSA）的风险高2倍。单变量线性回归分析显示，ACR与LVM之间呈正相关，LVM以LVM/h²或LVM/BSA表示，logACR与心室间直径和射血分数之间也呈直接相关性。回归模型包括logACR、估计肾小球滤过率、BMI、年龄、高血压病程、吸烟和MetS（作为单一变量以及每个单一成分），结果显示只有logACR、BMI、高血压病程和收缩压（SBP）与LVM/h²独立相关。
除了血压和BMI外，晨尿样本中以ACR测量的白蛋白尿是高血压患者心脏器官损害和心血管风险增加的一个有价值的低成本指标，且独立于MetS。另一方面，MetS不是心脏损害的独立危险因素，因为它似乎对心脏和肾脏亚临床器官损害之间的关系没有比其各成分（尤其是SBP和以BMI表示的肥胖）之和更多的影响。
