Authors: G B Doddamani, Joby Thomas Mammen
Int J Clin and Biomed Res 2015; 1 (3):64-71
Background: Target organ damage takes place early in course of hypertension. But, despite this, the disease remains inadequately controlled in majority of patients partly because of its asymptomatic nature. With incidence of hypertension on the rise, there have not been adequate studies in our country linking hypertensive target organ damage with microalbuminuria and creatinine clearance especially in asymptomatic patients. Aims: To find the relationship between microalbuminuria and reduced creatinine clearance with subclinical target organ damage in asymptomatic primary hypertensive patients. Material & Methods: 60 hypertensive patients were evaluated for mild renal dysfunction defined as 24 hour urine albumin(UA) > 30 mg/d and/or Creatinine Clearance (CCR) < 60 ml/min/1.73m2 .Target organ damage evaluated were retinopathy (direct fundoscopy) and Left ventricular hypertrophy (2D ECHO). Results: There was significant association between microalbuminuria (30 %) and reduced creatinine clearance (38%) with target organ damage i.e. left ventricular hypertrophy [p < 0.001 & p 0.001 respectively] and hypertensive retinopathy [p 0.005 & p 0.03 respectively]. Patients with urine microalbumin had 30 times risk [95% CI: 3.6-253,p 0.001] and those with reduced creatinine clearance had 5.9 times the risk [95% CI: 1.7-19.4, p 0.0035] of developing target organ damage. But when present together the risk increased to 39.4 times [95% CI: 2.2-703, p 0.0124]. Conclusions: Results show that a reduction in creatinine clearance and/or presence of microalbuminuria is a marker of subclinical organ damage in patients with primary hypertension. Microalbuminuria showed better association with target organ damage than reduced creatinine clearance.
KEYWORDS: Microalbuminuria, mild renal dysfunction, primary hypertension, subclinical, retinopathy, target organ damage.