Left ventricular geometry and function in patients with essential hypertension and microalbuminuria

Background Microalbuminuria has recently emerged as a strong, independent p redictor of cardiovascular mortality in patients with essential hypertensio n, yet the pathophysiological mechanisms underlying this association remain to be elucidated. Objective To study the relationship between microalbuminuria and left ventr icular geometry and function and extra-cardiac vascular changes in a group of 211 untreated hypertensive patients, Methods Albuminuria was evaluated as albumin-to-creatinine ratio in three n on-consecutive first morning urine samples. Left ventricular mass index and function were assessed by M-B mode echocardiography and carotid wall thick ness by high-resolution ultrasound scan. Results The prevalences of microalbuminuria and left ventricular hypertroph y were 14 and 47% respectively. Patients in the top quartile of albuminuria showed a higher left ventricular mass index (57 +/- 1.8, 55 +/- 2, 47 +/- 1.4 and 48 +/- 1.6 g/m(2.7), respectively; P< 0.0001) as well as a higher p revalence of left ventricular hypertrophy (72, 65, 26 and 25%, respectively ; P< 0.001) and especially concentric hypertrophy (56, 47, 17 and 21%, resp ectively; P< 0.0001) in the four quartiles of albuminuria. Microalbuminuric patients showed depressed left ventricular performance as indicated by a r educed midwall fractional shortening (15.7 +/- 0.3, 15.9 +/- 0.3, 16.7 +/- 0.4 and 16.8 +/- 0.3%, respectively; P< 0.02). Furthermore patients in the top quartile of albuminuria showed increased carotid wall thickness as comp ared to normoalbuminuric patients (0.78 +/- 0.03, 0.7 +/- 0.04, 0.65 +/- 0. 03 and 0.6 +/- 0.03 mm, respectively; P< 0.001). Conclusions Hypertensive patients with microalbuminuria show a higher preva lence of unfavourable left ventricular geometric patterns, depressed left v entricular function and early signs of extra-cardiac vascular damage. These findings strengthen the role of microalbuminuria as an indicator of subcli nical cardiovascular disease and may account for the worse outcome that is usually associated with increased urinary albumin excretion in essential hy pertension. J Hypertens 1999, 17:993-1000 (C) Lippincott Williams & Wilkins .