A Study on Microalbuminuria in Systemic Hypertension as an Indicator of Target Organ Damage

Hemanath, T R (2006) A Study on Microalbuminuria in Systemic Hypertension as an Indicator of Target Organ Damage. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: BP level per se has long been acknowledged as an unreliable indicator of subsequent morbid events in patients with primary hypertension. Recently, the concept that global cardiovascular risk, rather than the severity of hypertension, should guide both the decision to begin treatment and the identification of individual target pressure levels has been endorsed by international agencies. In fact, results of large epidemiological studies clearly demonstrated that regardless of the severity of hypertension, the cost effectiveness of BP reduction by means of drug therapy is greater in the presence of target organ abnormalities and/or co-morbidities. In this context, assessment of subclinical organ damage, namely of left ventricular hypertrophy and peripheral atherosclerosis, however, very much depends on the diagnostic technique employed. Routine use of ultrasound technology, for example, leads to higher sensitivity in detecting cardiac and vascular structure abnormalities and allows identifying large number of high-risk patients. On the other hand, the high prevalence of hypertension and its financial impact in health care systems should be carefully taken into consideration before recommending routine application of an expensive diagnostic approach to the stratification of risk. Thus, the development of low cost, accurate, clinical tools to identify hypertensive patients at highest risk is of the utmost importance. OBJECTIVES: 1. To correlate the presence of microalbuminuria and the presence of subclinical target organ damage in patients with essential hypertension. 2. To ascertain relationship between amount of albumin excreted and severity of target organ damage. MATERIALS AND METHODS: 250 patients, newly diagnosed or recently diagnosed (less than one year, on treatment), essential hypertensives following up at the hypertensive clinic, Government General Hospital, Chennai were enrolled for the study between May 2004 and June 2005. Of them, 192 patients were excluded as per exclusion criteria. Remaining 58 patients were selected for the study who satisfied all the exclusion and the inclusion criteria. Written consent was obtained from all patients participated in the study. Exclusion criteria: 1. Patients older than 60 years, 2. Hypertension duration > 1 year, 3. Diabetes mellitus, chronic kidney disease, 4. Chronic heart failure, 5. Positive history (or) clinical evidence of IHD, 6. Patients on diuretics, ACEIs, ARBs, 7. Severe obesity. STATISTICAL ANALYSIS: Statistical analysis was carried out for 58 subjects 32 persons in the control group whose albumin excretion is within normal limits, 26 persons in the microalbuminuric group after categorizing each variable. Patients age, sex, weight, BMI, Serum lipid profile were matched. Occurrence of target organ damage by IMT, LV mass index and Fundal examination were tabulated and analyzed. Microsoft excel 2003 was used for analysis and Z tests were done to assess differences between percentages and difference between means. Correlation was evaluated by the software. Statistical significance was taken when P<0.05. CONCLUSION: The following are conclusions from the study: 1. Subclinical target organ damage is common in systemic hypertension, the probability of which is significantly increased in patients with microalbuminuria. 2. In patients with microalbuminuria, the severity of target organ damage is directly related to the amount of albumin excretion in urine. 3. Microalbuminuria is an independent risk factor for target organ damage in systemic hypertension.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Microalbuminuria ; Systemic Hypertension ; Indicator ; Target Organ Damage
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 24 Mar 2018 17:39
Last Modified: 25 Mar 2018 02:52
URI: http://repository-tnmgrmu.ac.in/id/eprint/6545

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