Predictive value of spot urine albumin-to-creatinine ratio for echocardiography-based left ventricular hypertrophy among newly diagnosed hypertensive patients
Keywords:
Hypertension, microalbuminuria, albumin-to-creatinine ratio, left ventricular hypertrophyAbstract
Objective: Studies have reported high prevalence of left ventricular hypertrophy (LVH) among patients with microalbuminuria. Both left ventricular hypertrophy and microalbuminuria (MA) are associated with increased risk of cardiovascular morbidity and mortality. The study aimed to determine the predictive value of spot urine albumin-to-creatinine ratio (ACR) for echocardiography-based LVH in newly diagnosed hypertensive patients.
Methods: LVH was defined as left ventricular mass index (LVMI) of >115g/m2 in males and >95g/m2 in females. Microalbuminuria was defined as ACR >30 mg/g and diagnostic value of MA for LVH assessed using X2 2by2 table and the Receiver Operating Characteristics (ROC) curve plot.
Results: Sixty six (48.5%) males and 70(51.5%) females with a mean age of 44.8(10.5 %) years were studied. Left ventricular hypertrophy was observed in 36.8% while 42.7% had MA. The prevalence of MA in those with LVH was 66%. Microalbuminuria showed a sensitivity of 64% and specificity of 70% for echocardiography (echo) detected LVH, while the positive predictive value (PPV) and negative predictive value (NPV) were 55% and 77% respectively. Diagnostic accuracy of MA for echo LVH was 68% with an odd ratio of 4.1. ROC curve plot revealed an area under the curve of 0.73 at ACR of 36mg/g, improving the sensitivity and NPV to 85.7% and 83.8% respectively.
Conclusion: Microalbuminuria predicts LVH in treatment naïve Nigerian hypertensive patients. This can be used as a surrogate for LVH in outpatient settings, providing vital information for comprehensive management of patients.
References
Kannel WB. Blood pressure as a cardiovascular risk factor: Prevention and treatment. JAMA 1996; 275:1571–1576
Redon J, Baldo E, Lurbe E, Bertolin V, Lozano J, Miralles A et. al. Microalbuminuria, left ventricular mass and ambulatory blood pressure monitoring. Kidney Int 1996;49:S81 -S84
Pontremoli R, Ravera M, Bezante GP, Viazzi F, Nicolella C, Berutti V et. al.
Left ventricular geometry and function in patients with essential hypertension an d m i c r o a l b u m i n u r i a . J Hypertens1999;17:993 – 1000
Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B et al. Albuminuria and risk of cardiovascular events, death, and heart failure in 13. diabetic and non-diabetic individuals. JAMA 2001;286:421-426
systemic hypertension. Niger J Med 2007;16:119-24
Salako BL, Ogah OS, Adebiyi AA, Oladapo OO, Aje A, Adebayo AK et al. Unexpectedly high prevalence of target organ damage in newly diagnosed Nigerians with hypertension.
Cardiovasc J Afr 2007;18: 77 – 83
Alebiosu CO, Odusan B, Familoni OB, Jaiyesimi AEA. Pattern of occurrence of microalbuminuria among dippers and non-dippers (essential
hypertensives) in a Nigerian university teaching hospital. Cardiovasc J Afr 2004; 15:9 – 12
Odili AN, Okeahialam BN. Prevalence a n d c l i n i c a l c o r r e l a t e s o f
Microalbuminuria in newly diagnosed non-diabetic hypertensive patients. Abstract presented at the Nigerian
Cardiac Society Annual General Conference Abuja 2007
Post WS, Blumenthal RS, Weiss JL,
Levine DM, Thiemann DR,
Gerstenblith G et al. Spot Urinary Albumin–Creatinine Ratio Predicts Left Ventricular Hypertrophy in Young Hypertensive African-American Men. AJH 2000;13:1168–1172
Pontremoli R, Sofia A, Ravera M, Nicolella C, Viazzi F, TirottaA et al. Prevalence and clinical correlates of microalbuminuria in essential hypertension: The MAGIC study.
Hypertension 1997;30:1135–1143
Swynghedauw B. Molecular mechanisms of myocardial remodeling. Physiol Rev 1999;79:216 –261
Summerson JH, Bell RA, Konen JC. Racial difference in the prevalence of microalbuminuria in hypertension. Am J Kidney Dis 1995;26:577-579
Jensen JS, Feldt-Rasmussen B,
Strandgaard S, Schroll M, Borch-
Jonsen K. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease. Hypertension
;35:898–903
Olsen MH, Wachtell K, Bella JN, Palmieri V, Gerdts E, Smith G. Albuminuria predicts cardiovascular events independently of left ventricular mass in hypertension: a LIFE sub study. J Human Hypertens
;18:453-459
Tsioufis C, Stefanadis C, Toutouza M, allikazaros I, Toutouzas K, Tousoulis D et al. Microalbuminuria is associated with unfavorable cardiac geometric adaptations in essential hypertensive subjects. J Hum Hypertens
;16:249–254
Jensen JS, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B. atherosclerotic risk factors are increased in clinically h e a l t h y s u b j e c t s w i t h
microalbuminuria. Atherosclerosis 1995;112:245-252
Jensen JS. Renal and systemic transvascular albumin leakage in severe atherosclerosis. Arterioscler Thromb Vasc Biol 1995;15:1324-1329
Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991;114:345-352
Agrawal B, Berger A, Luft FC. Microalbuminuria screening by reagent strip predicts cardiovascular risk in hypertension. J Hypertens
;14:223- 228
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Research Journal of Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Research Journal of Health Sciences journal is a peer reviewed, Open Access journal. The Journal subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons License (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). All articles are made freely accessible for everyone to read, download, copy and distribute as long as appropriate credit is given and the new creations are licensed under the identical terms.
