This Article Full Text Full Text (PDF) All Versions of this Article: 24/12/2414    most recent 01.ATV.0000147415.40692.7fv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pedrinelli, R. Articles by Penno, G. Search for Related Content PubMed PubMed Citation Articles by Pedrinelli, R. Articles by Penno, G. Related Collections Clinical Studies Epidemiology Endothelium/vascular type/nitric oxide Risk Factors

(Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:2414.)
© 2004 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Low-Grade Inflammation and Microalbuminuria in Hypertension

Roberto Pedrinelli; Giulia Dell’Omo; Vitantonio Di Bello; Giovanni Pellegrini; Laura Pucci; Stefano Del Prato; Giuseppe Penno

From the Dipartimento Cardio Toracico, Laboratorio Analisi Chimiche e Microbiologiche (R.P., G.D., V.D., G. Pellegrini), Azienda Ospedaliera Pisana (R.P., G.D., V.D., G. Pellegrini), Endocrinologia e Metabolismo (L.P., S.D., G. Penno), Università di Pisa, Italy.

Reprint requests to Roberto Pedrinelli MD, Università di Pisa, Dipartimento Cardio Toracico, Paradisa 2, Pisa, 56100 Italy. E-mail r.pedrinelli{at}int.med.unipi.it

Background— Albuminuria and C-reactive protein (CRP), a marker of systemic low-grade inflammation, are frequently elevated in essential hypertension and predict cardiovascular prognosis independent of conventional risk factors. However, in spite of their potentially important links, the interrelationships between the 2 parameters have not been explored in depth in hypertensive patients.

Methods and Results— Albuminuria (the mean of 3 overnight urine collections), high-sensitive CRP (hs-CRP), 24-hour blood pressure (BP), weight, lipids, poststimulative (75 g PO) plasma glucose, insulin, and insulin sensitivity by the homeostasis model assessment model were evaluated in 220 never treated, nondiabetic, uncomplicated essential hypertensive men. Albuminuria 15 µg/min was defined as microalbuminuria and hs-CRP values above and below median (2.3 mg/L) as high and low, respectively. Concentric left ventricular hypertrophy was diagnosed by echocardiography, and a full-blown metabolic syndrome was identified in presence of hypertension and at least 3 of following: obesity, subclinical hyperglycemia, low high-density lipoprotein (HDL) and high triglycerides. Microalbuminuria was present in 54 patients, 29 with high hs-CRP characterized by higher 24-hour systolic BP, postload glucose, body mass index, lower HDL cholesterol, more frequent metabolic syndrome, concentric LVH, and active smoking than those with either isolated microalbuminuria (n=27) or normoalbuminuria.

Conclusions— Microalbuminuria accompanied by evidence of subclinical inflammation is a strong correlate of metabolic abnormalities in essential hypertension and identifies a patient subset at very high cardiovascular risk. In contrast, isolated microalbuminuria may represent a distinct pathophysiological condition characterized by a more benign profile and possibly a better prognosis.

Microalbuminuria accompanied by high hs-CRP was characterized by higher 24-hour SBP, postload glucose, BMI, lower HDL cholesterol, more frequent metabolic syndrome, concentric LVH, and active smoking indicating that this phenotypic pattern is a strong correlate of metabolic abnormalities in essential hypertension and identifies a patient subset at very high cardiovascular risk.

Key Words: low-grade inflammation • C-reactive protein • microalbuminuria • left ventricular hypertrophy • essential hypertension

This article has been cited by other articles:

				J. A Nettleton, L. M Steffen, W. Palmas, G. L Burke, and D. R Jacobs Jr Associations between microalbuminuria and animal foods, plant foods, and dietary patterns in the Multiethnic Study of Atherosclerosis Am. J. Clinical Nutrition, June 1, 2008; 87(6): 1825 - 1836. [Abstract] [Full Text] [PDF]

				N. Tentolouris, R. Nzietchueng, V. Cattan, G. Poitevin, P. Lacolley, A. Papazafiropoulou, D. Perrea, N. Katsilambros, and A. Benetos White Blood Cells Telomere Length Is Shorter in Males With Type 2 Diabetes and Microalbuminuria Diabetes Care, November 1, 2007; 30(11): 2909 - 2915. [Abstract] [Full Text] [PDF]

				G. F. Salles, R. Fiszman, C. R.L. Cardoso, and E. S. Muxfeldt Relation of Left Ventricular Hypertrophy With Systemic Inflammation and Endothelial Damage in Resistant Hypertension Hypertension, October 1, 2007; 50(4): 723 - 728. [Abstract] [Full Text] [PDF]

				T. Omland, M. H. Drazner, T. Ueland, M. Abedin, S. A. Murphy, P. Aukrust, and J. A. de Lemos Plasma Osteoprotegerin Levels in the General Population: Relation to Indices of Left Ventricular Structure and Function Hypertension, June 1, 2007; 49(6): 1392 - 1398. [Abstract] [Full Text] [PDF]

				T. J. Wang, P. Gona, M. G. Larson, D. Levy, E. J. Benjamin, G. H. Tofler, P. F. Jacques, J. B. Meigs, N. Rifai, J. Selhub, et al. Multiple Biomarkers and the Risk of Incident Hypertension Hypertension, March 1, 2007; 49(3): 432 - 438. [Abstract] [Full Text] [PDF]

				L. Jorgensen, T. Jenssen, S. H. Johnsen, E. B. Mathiesen, I. Heuch, O. Joakimsen, E. Fosse, and B. K. Jacobsen Albuminuria as risk factor for initiation and progression of carotid atherosclerosis in non-diabetic persons: the Tromso Study Eur. Heart J., February 1, 2007; 28(3): 363 - 369. [Abstract] [Full Text] [PDF]

				G McGwin, T A Hall, A Xie, and C Owsley The relation between C reactive protein and age related macular degeneration in the Cardiovascular Health Study Br. J. Ophthalmol., September 1, 2005; 89(9): 1166 - 1170. [Abstract] [Full Text] [PDF]