Microalbuminuria, pulse pressure, left ventricular hypertrophy, and myocardial ultrasonic tissue characterization in essential hypertension

Microalbuminuria (UAE) may be considered a marker of systemic vascular dysf unction, while pulse pressure (PP) is an indicator of the stiffness of vasc ular conduits. Both these parameters, together with left ventricular hypert rophy (LVH), are linked to cardiovascular morbidity in hypertensive patient s. The aim of this study was the analysis of the possible relationships amo ng UAE, PP, and LVH with ultrasonic myocardial textural parameters, which a re altered in hypertensives patients. A group of male (n = 70) essential hy pertensive patients (mean age: 58 +/- 7 yr) was analyzed with a group of ag e-comparable normotensive healthy subjects as controls (n = 32). Ambulatory blood pressure monitoring (ABPM) was performed with an oscillometric monit or; UAE was measured by nephelometry. A conventional 2D-Doppler echocardiog raphy (to analyze left ventricular mass: LVM) and a quantitative analysis o f the echocardiographic digitized imaging with the use of a calibrated digi tization system (to calculate the septum and the posterior wall textural pa rameters) were performed on ail subjects. The myocardial mean gray level wa s calculated to derive the cyclic variation index (CVI). The CVI was significantly lower in hypertensives both for the septum (-16.3 +/- 22.8 vs 34.7 +/- 15.3%; p < 0.001) and for the posterior wall (-15.2 < plus/minus> 23.6 vs 38.2 +/- 15.4%; p < 0.001). A significant negative corr elation was found between logUAE and the CVI of the septum (r = -0.42; p < 0.001), between the PP and the CVI of the septum (r = -0.40; p < 0.002) and between the CVI and the LVM (r = -0.38; p < 0.001). Multiple regression an alysis having as dependent variable the CVI at septum level showed as signi ficantly related independent variables: PP (p < 0.01), logUAE (p < 0.001), and LVM (p < 0.05) (multiple a 0.76, squared multiple a 0.57; p < 0.001). It was found that LVM, logUAE, and PP are ail correlated with textural para meters, and the CVI can be considered a sensitive parameter in the identifi cation of an abnormal myocardial texture in hypertension, A high level of a rterial stiffness and the presence of vascular dysfunction in essential hyp ertension could participate in the determination of myocardial alterations and permit the identification of patients with the worst prognosis in terms of morbidity or mortality due to cardiovascular events.