Usefulness of microalbuminuria in cardiovascular risk stratification of essential hypertensive patients

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Abstract

Background/Aims: To evaluate the influence of microalbuminuria(albumin excretion rate – AER) determinationand echocardiography (ECHO) on cardiovascular riskstratification, initially performed according the 1999WHO/ISH guidelines by using only routine diagnosticprocedures with or without fundal examination. Methods:312 essential hypertensives attending our institutionwere studied retrospectively. Cardiovascular riskwas assessed in a semiquantitative way using four categoriesof absolute cardiovascular disease risk (low, medium,high and very high risk), as proposed by the 1999WHO/ISH guidelines, on the basis of data on the average10-year risk of cardiovascular events among participantsin the Framingham Study. Results: Without the retinaldata, estimating the level of global cardiovascular risk onthe basis of routine work-up alone, 14% were classifiedas low-risk patients, 48% were as medium-risk, 20% ashigh-risk and 18% at very-high-risk patients. The combineduse of AER and ECHO, in line with the newer ESHESCguidelines, determined a statistically significant reclassificationof the hypertensive patients. Only 10%remained in the low-risk category, 28% were classified inthe medium-, 42% in the high- and 20% in the very-highriskclasses. The overall percentage of patients thatchanged risk stratum (mostly shifting from the mediumtothe high-risk class) was significantly different from theproportion of subjects reclassified after the addition ofeither microalbuminuria or echocardiography alone. Nochange in the distribution of risk categories was observedwhen AER assay and ECHO were added to routineprocedures including funduscopic examination.Conclusions: Considering the questionable prognosticvalue of qualitative retinal examination, our results suggestthat cardiovascular risk evaluation based only onsimple routine work-up, ignoring the information providedby AER determination and ECHO, may underestimatethe level of absolute risk.
Original languageEnglish
Pages (from-to)123-127
Number of pages5
JournalNEPHRON CLINICAL PRACTICE
Volume96
Publication statusPublished - 2004

All Science Journal Classification (ASJC) codes

  • Nephrology

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