The Clinical Value Of Random Microalbuminuria In The Assessment Of Asymptomatic Target Organ Damage In Patients With Hypertension

Objective Early detection and management of asymptomatic target organ damage(TOD)in hypertensive patients has great significance in reducing clinical complications.The new concept of hypertension management is early prevention and treatment of hypertension,asymptomatic TOD,so as to improve long-term prognosis and prevent stroke,renal damage and left ventricular hypertrophy,as well as heart failure and coronary heart disease.With the progressive diagnosis and treatment of hypertension,more and more hypertension patients are managed mainly in the community or in outpatient clinics of different grade hospitals.Due to the Limited medical resources in communities and hospitals,it is necessary to find a simple,rapid and accurate screening method for TOD,which is very important for detecting symptomatic TOD,and for improving pnognosis of the patients in community.The aim of this study is to investigate the value of random microalbuminuria(MAU)detection in hypertensive patients at outpatient clinic,and to find out the relationship between early renal function impairment and asymptomatic TOD.Methods From December 7,2015 to November 1,2017,1198(average age 54.80 ±12.43;582 males;Females 616)patients with essential hypertension were enrolled as hypertension group,and 1167(average age 55.27±9.84;588 males;579 women)healthy people were selected as controls.The research protocol was passed by The Ethic Committee of Lanzhou University Second Hospital(2015A–113).Hypertensive group was further divided into MAU positive group and MAU negative group according whether had MAU of them.The age,sex,height,body weight,systolic blood pressure(SBP)and diastolic blood pressure(DBP)were recorded in each group.Serum cystatin and renal function were measured,including microalbumin(MAU),blood urea nitrogen(BUN),creatinine(CRE),uric acid,blood glucose,blood lipid,blood homocysteine,liver function and thyroid function.The left ventricular end-diastolic diameter,interventricular septum thickness and left ventricular posterior wall thickness in hypertensive group were measured by echocardiography,and carotid intima-media thickness and plaque were examined by carotid artery ultrasonography.Data was analysis by SPSS software version 22.0.The normal distribution data was expressed by mean standard deviation(),the non-normal distribution data was expressed by median,the non-parametric test was adopted,the measurement data was t-test,and the counting data are compared by chi-square test.P < 0.05,the difference was statistically significant.Results Hypertension group and control group in the proportion of age,gender,height,weight,BMI,blood glucose,and high density lipoprotein cholesterol(HDL-c)index,there was no statistically significant difference(P > 0.05),the two group in blood fat,clinic SBP and DBP,blood BUN,CRE,blood uric acid,eGFR,blood cystatin comparative difference was statistically significant(P < 0.05).In MAU positive group and negative group of the hypertensive patients,there was no significant difference in sex ratio,height,weight,BMI,total cholesterol,triglyceride,low density lipoprotein,blood glucose(P>0.05),but there were statistically differece for age,SBP and DBP,blood cystatin,blood uric acid,serum BUN,CRE,eGFR and HDL-c difference(P<0.05).The incidence of MAU in hypertensive group(33.9%)was significantly higher than that in control group(1%)(P < 0.05).The incidence rate of MAU was also different along with(P<0.05).There are differences in MAU positive group and negative group as the research object,using MAU as dependent variable,age,height,weight,BMI,SBP and DBP,urea nitrogen,creatinine,uric acid,blood lipid,blood glucose and duration as independent variables.Logistic regression analysis showed that age,SBP,DBP and course of hypertension is a major risk factor for MAU.In the hypertension group,the levels of eGFR and serum cystatin in MAU positive group and negative group were different(P<0.05),and the MAU were correlated with the changes of eGFR and serum cystatin.In the hypertensive group,according to the different duration time(<5 = 5,duration <10 years,more than 10 years)the incidence rate of MAU(respectively: 15.36%,33.22% and 56.81%)along with increasing of the time of the course of the increase,the positive rate of MAU also increased accordingly(P<0.001).In the MAU positive group,the detection rate of left ventricular hypertrophy and carotid atherosclerosis was higher than that in the MAU negative group,which were 54.59% vs 26.19%,64.04% vs 48.10%,respectively,and this difference was also statistically significant(P<0.001).Conclusion When MAU can be detected in urine in patients with hypertension,the urine protein can still be negative.It can be used to screen early renal damage and guide the treatment.The occurrence of MAU in hypertensive patients is related to the level of blood pressure,duration course of disease and serum cystatin abnormality.Therefore,it is reliable to detect MAU in outpatient clinic with random urine to assess early renal damage in hypertension.In addition,the presence of MAU is associated with asymptomatic carotid atherosclerosis and left ventricular hypertrophy.Therefore,it can also be used as a predictor of other asymptomatic target organ damage.We need more evidence and futher study about this.