on October 14, 2004
Published online before print October 14, 2004, doi: 10.1161/01.ATV.0000147415.40692.7f
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Submitted on June 22, 2004
Accepted on September 8, 2004
Low-Grade Inflammation and Microalbuminuria in Hypertension
Roberto Pedrinelli *;
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.
* To whom correspondence should be addressed. 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 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.
Key words: low-grade inflammation • C-reactive protein • microalbuminuria • left ventricular hypertrophy • essential hypertension
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