Redon J, Baldo E, Lurbe E, Bertolin V, Lozano J V, Miralles A, Pascual J M
Hypertension Clinic, Hospital Clinico, University of Valencia, Spain.
Kidney Int Suppl. 1996 Jun;55:S81-4.
The objective of the present study was to assess the relationship between microalbuminuria (Malb) and left ventricular hypertrophy (LVH), when levels of ambulatory BP was token in to account as a confounder factor. Patients with essential hypertension, aged 25 to 50 years old, never treated with antihypertensive drugs, were included in the study. The inclusion criteria were: (a) absence of diabetes, renal disease or urinary tract infection; (b) urinary albumin excretion (UAE) estimated in urine of 24 hours in two separate days; (c) echocardiography suitable for measurement of left ventricular mass (LVM); and (d) good quality ambulatory blood pressure monitoring during 24 hours. UAE was measured using a immunonephelometric assay (Behring Institute) and Malb was considered when UAE 30 to 300 mg/24 hours during the two days. LVM was calculated by the Devereaux formula and referred to height (LVMI g/m). AMBP was performed using an oscilometric device (Spacelabs 90202 or 90207) during a regular working day. Readings were programmed every 20 minutes between 6 a.m. to midnight and thereafter every 30 minutes. The average BP during a 24 hour period was calculated. One hundred and fifty one patients (96 male, mean age 37 +/- 8 years, body mass index 27.7 +/- 3.7 g/m2) were included. The average values of office BP was 148 +/- 15/96 +/- 8 mm Hg, and the average BP during 24 hours was 137 +/- 13/88 +/- 12 mm Hg. UAE was 30.1 +/- 52.3 mg/24 hr and the LVMI 140.6 +/- 44.1 g/m. The percentage of Malb patients was 28% and those with LVH 34%. A significant relationship between UAE and office and ambulatory SBP and DBP was observed. LVMI was also significantly related to ambulatory SBP and DBP, a relationship that was not found for office BP. In a multiple regression model, significant relationship between UAE and LVMI emerged, independent of diastolic ambulatory BP, age and sex (P < 0.04). In conclusion; we observed a significant relationship between UAE and LVMI, in part, independent of blood pressure. The fact that Malb is associated with the presence of LVH, supports the idea that Malb is a risk marker in essential hypertensive patients.
本研究的目的是在将动态血压水平作为混杂因素考虑在内的情况下，评估微量白蛋白尿（Malb）与左心室肥厚（LVH）之间的关系。纳入研究的患者为25至50岁的原发性高血压患者，从未接受过抗高血压药物治疗。纳入标准为：（a）无糖尿病、肾病或尿路感染；（b）在两个不同日期对24小时尿液中的尿白蛋白排泄量（UAE）进行评估；（c）超声心动图适合测量左心室质量（LVM）；（d）24小时动态血压监测质量良好。使用免疫比浊法（贝林研究所）测量UAE，当两天内UAE为30至300mg/24小时时，认定为微量白蛋白尿。LVM通过德弗罗公式计算，并参考身高（左心室质量指数，g/m）。在正常工作日使用示波装置（太空实验室90202或90207）进行动态血压监测。上午6点至午夜期间每20分钟进行一次读数，之后每30分钟进行一次读数。计算24小时期间的平均血压。共纳入151例患者（96例男性，平均年龄37±8岁，体重指数27.7±3.7g/m2）。诊室血压的平均值为148±15/96±8mmHg，24小时平均血压为137±13/88±12mmHg。UAE为30.1±52.3mg/24小时，左心室质量指数为140.6±44.1g/m。微量白蛋白尿患者的比例为28%，左心室肥厚患者的比例为34%。观察到UAE与诊室及动态收缩压和舒张压之间存在显著关系。左心室质量指数也与动态收缩压和舒张压显著相关，而诊室血压未发现这种关系。在多元回归模型中，UAE与左心室质量指数之间出现显著关系，独立于动态舒张压、年龄和性别（P<0.04）。总之，我们观察到UAE与左心室质量指数之间存在显著关系，部分独立于血压。微量白蛋白尿与左心室肥厚的存在相关这一事实，支持了微量白蛋白尿是原发性高血压患者风险标志物的观点。
