Microalbuminuria Bose T

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Microalbuminuria Bose T

  1. 1. A STUDY ON MICROALBUMINURIA AS A PREDICTIVE MARKER OF TARGET ORGAN DAMAGE IN HYPERTENSION<br />Dr. Tanoy Bose<br />Co authors: <br />Kalita HC, Laskar B, Gogoi GN, Baruah K, Kotokey D, Das K, Dutta A<br />
  2. 2. Introduction<br />Accurate cardiovascular risk evaluation: a prerequisite for devising cost-effective therapeutic strategies in patients with essential HTN.<br />Microalbuminuria, an integrated marker of target organ damage and, therefore, of global risk, could prove to be a valuable tool in the screening and identification of hypertensive patients who are at higher cardiovascular risk.<br />Evidence : Regression of left ventricular hypertrophy parallels the reduction of albuminuria to some degree regardless of BP changes.†<br />†Olsen MH, Wachtell K, Borch-Johnsen K, Okin PM, Kjeldsen SE, Dahlof B, Devereux RB, Ibsen HA:. Losartan Intervention For Endpoint reduction. J Hum Hypertens 16: 591 595, 2002<br />
  3. 3. Aims and Objectives<br />Prevalence of microalbuminuria (MAU) among hypertensive patients <br />Co-relationship of microalbuminuria with duration & severity of hypertension, sex, dyslipidemia and ceratin specific target organ damage due to hypertension<br />
  4. 4. Methodology<br />Non-randomized, cross-sectional, observational study.<br /> 128 cases of hypertension : JNC 7 criteria. <br />Duration: 1 year from July 2005 to June 2006. <br />Examined clinically, routinely investigated along with creatinine clearance, lipid profile, ophthalmoscopy, ECG and urine MAU estimation.<br />
  5. 5. Inclusion criteria<br /><ul><li>Age > 18 yrs
  6. 6. Asymptomatic + BP > 140/90 mm Hg</li></ul>Exclusion criteria<br /><ul><li>Diabetes
  7. 7. Renal failure
  8. 8. CCF
  9. 9. Pre-existing renal disease
  10. 10. UTI
  11. 11. Pregnancy
  12. 12. Fever
  13. 13. Drugs affecting kidneys [eg. Aminoglycosides, NSAIDs]
  14. 14. Rx with ACEI or ARB
  15. 15. Macroalbuminuria
  16. 16. Smoker</li></li></ul><li>Results <br />
  17. 17. Results <br />
  18. 18. Results <br />
  19. 19. Summary of Results<br /><ul><li>Prevalence of MAU: 37.5%
  20. 20. 40.38% of Stage II Htn had MAU vs 25% in Stage I Htn.
  21. 21. In MAU group, mean BP was 169.75±12.68 / 91.5±5.96 mm Hgvs145.62 ± 10.32/ 90.4 ± 2.45 mm Hg in non MAU group.
  22. 22. MAU more prevalent among males ( 45.45%) than females ( 20.0%)</li></li></ul><li>Summary of Results : contd<br /><ul><li>Mean age of patients having MAU : 56.29 ± 9.07 yrs.
  23. 23. Prevalence of MAU increased with age [38.88% in 31-40yrs vs 61.53% in >60yrs]
  24. 24. 58.33% of pts having MAU had a disease duration of >9yrs vs 18.75% with a duration of 4-6 yrs.
  25. 25. 63.63% of male obese had MAU vs 25% of female obese.</li></li></ul><li>Summary of Results : contd<br />62.5% of pts with MAU had Retinopathy [ of which 28.57% grade I & 71.43% grade II] <br />Retinopathy prevalence increased with the severity of Htn. [47.6% among Stage II Htn with MAU vs16.6% among Stage I Htn with MAU].<br />79.16% pts with MAU showed ECG changes of LVH.<br />MAU more prevalent in pts with low HDL [<40mg/ml]75%, high LDL[>150mg/dl]79.16%.<br />MAU had no correlation with CrCl.<br />
  26. 26. Conclusion <br /><ul><li>Microalbuminuria was quite prevalent in patients suffering from Hypertension. The prevalence was found to be 37.5%.
  27. 27. Microalbuminuria showed a positive correlation with the
  28. 28. Duration of Hypertension
  29. 29. Severity
  30. 30. Male sex
  31. 31. Obesity
  32. 32. Low HDL levels (<40mg/dl)
  33. 33. High LDL levels (>150mg/dl)
  34. 34. Retinopathy
  35. 35. Evidence of left ventricular hypertrophy.</li></li></ul><li>Microalbuminuria <br /><ul><li>Microalbuminuria should be looked for in all patients suffering with Hypertension preferably early in the course.
  36. 36. May be considered as an indicator of early interventions to prevent or retard organ damage</li></ul>Take Home Message<br />
  37. 37. THANK YOU<br />

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