engleski

TUBULAR PROTEINURIA IN HYPERTENSION

OBJECTIVE: Prehypertension has been recognized as a condition associated with increased cardiovascular risk. Our aim was to analyse differences in characteristics of prehypertensives, normotensives and hypertensives, with emphasis on renal function in prehypertension. DESIGN AND METHODS: Out of 2489 subjects enrolled in Croatian rural study, 933 (405 male, 528 female) were eligible for further analysis. Exclusion criteria were antihypertensive treatment, diabetes mellitus, pregnancy, chronic terminal diseases, dementia, immobility and missing data. Blood pressure (BP) and heart rate (HR) were measured following the ESH guidelines. BMI and waist circumference (WC) were determined. Fasting blood was analysed for glucose(FBG), insulin, total cholesterol(T-C), HDL, LDL, triglycerides(TG), serum creatinine, haematocrite(Hct), C reactive protein(CRP) and white blood cell count(WBC). HOMA index was used to calculate insulin resistance and MDRD formula to estimate glomerular filtration rate (eGFR). Albumin to creatinine ratio (ACR) and alpha1 microglobin to creatinine ratio (alpha1CR) were determined. Subjects were divided in three groups: normotensives (<130/85 ; N=448), prehypertensives (130/85-139/89 ; N=144), and untreated hypertensives (>=140/90 ; N=341). RESULTS: Prehypertensives were significantly older and more obese, dyslipidemic, had higher CRP, Hct and HOMA index values than normotensives (p<0.05). No differences were observed in HR between these 2 groups (p>0.05). Additionally prehypertensives had a trend of lower eGFR (80.6 vs. 81.3, p=0.754) and significantly higher ACR and alpha1CR than normotensives (4.9 vs. 4.0, p=0.003 ; 4.9 vs. 4.2, p=0.009 respectively). In comparison with hypertensives, prehypertensives were significantly younger, less viscerally obese, had lower HR, FBG and T-C (p<0.05). However no differences in BMI, Hct, LDL, HDL, TG, HOMA and CRP were observed (p>0.05). CONCLUSION: Prehypertensives significantly differ from normotensives in metabolic disturbances and renal impairment. Not only albuminuria but also proximal tubule damage is observed in prehypertension. However no differences between prehypertensives and hypertensives in majority of the measured variables were found, all of which could contribute to increased cardiovascular risk in prehypertensives. Higher values of alpha1 microglobin excretion might point on early proximal tubule damage in prehypertension.

Prehypertension; proximal tubule damage

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