European Journal of Cardiovascular Medicine

Any of the following conditions is considered hypertension. Blood pressure at rest > 140 mm Hg blood pressure at diastole >90 Using any kind of antihypertensive drug¹ A significant contributor to morbidity and death is hypertension. High blood pressure mostly affects the heart, cerebral arteries, kidneys, retinal vasculature, and brain. The danger of injury to the target organ increases continuously as the systolic and diastolic values rise. A continuous and graded impact of both systolic and diastolic blood pressure on CHD mortality was shown in the multiple risk factor intervention trial (MRFIT), which included over 3.5 lakh male participants. The influence was shown to extend down to a systolic blood pressure of 120mmHg. For every 20 mm Hg systolic and 10 mm Hg diastolic increase in blood pressure, the risk of cardiovascular disease doubles.² Low levels of awareness, treatment, and control rates are associated with the significant differences in the regional burden of hypertension between LMIC and HIC. The ISH started a global effort to improve awareness of elevated blood pressure, known as the May Measurement Month project, in response to the low level of global awareness for hypertension (estimated at 67% in HIC and 38% in LMIC).^4,5

WHO/ISH guidelines have indicated the following manifestations of target organ damage as factors influencing prognosis⁶

1. Left ventricular hypertrophy 2. Radiological evidence of atherosclerotic plaque 3. Proteinuria /slight elevation of plasma creatinine concentration 4. Generalized /focal narrowing of the retinal arteries in hypertensive individuals left ventricular hypertrophy is an independent risk factor to cardiovascular morbidity and mortality⁷. Cardiovascular risk stratification can be done by identification of various geometric patterns of LV hypertrophy^8,9.

Microalbuminuria can be considered a specific integrated marker of cardiovascular risk and target organ damage in primary hypertension and one that is suitable for identifying patients at higher global risk¹⁰.Microalbuminuria is considered as strong, early and independent marker of increased cardiovascular risk in hypertension^11, and the risk is proportional to urine albumin excretion starting below conventional MAU threshold.

In hypertensive patients, Micro-Albuminuria has significant association with concentric and eccentric LV hypertrophy¹². Urine albumin creatinine ratio positively correlate with LV mass, systolic BP, age, pulse pressure and endocardial and mid-wall shortening but not to diastolic filling parameters¹².Micro albuminuria confers a fourfold increased risk of ischemic heart disease among hypertensive or borderline subjects¹³.

Micro-albuminuria is associated with atherogenic cardiovascular risk factors, endothelial dysfunction, impaired aortic mechanics and increased LV mass^14,15,16,17. Proteinuria in hypertensive renal disease^{,16,17,18,19,} may accelerate the decline of renal function and also amplify the risk of vascular disease. Losartan Intervention for end point reduction in hypertension (LIFE study) indicates that changes in urine albumin excretion under antihypertensive treatment parallel those of ECG determined LV mass. Determination of albuminuria can become a useful tool in evaluation of global cardiovascular risk²⁰.

The present study was undertaken in the Department of Internal Medicine Al Ameen Medical College Medical College and hospital.

After obtaining informed consent, a total of 100 Cases Admitted In medical wards and those attending medicine outpatient department in Al Ameen Medical College , Athani road, Bijapur During A Period From Nov 2018 To May 2020 who were recently diagnosed of  hypertension were selected for the present study.

Inclusion criteria:           

• Patients who are newly detected with hypertension, with systolic BP>130 mm hg and /or diastolic BP>80 in atleast 3 visits
• Age more than 20 years

Exclusion criteria: 

• Patients with age <20 years
• Patients with Diabetes Mellitus: Either history of diabetes or those newly detected [FBS>126 mg/dl; 2 hr PPBS>200mg/dl]
• Patients with history of ischemic heart disease or any other congenital /acquired heart diseases
• Patients with urinary tract infections by clinical presentation or laboratory investigations
• Patient with renal diseases or raised serum creatinine [>1.5 mg/dl]
• Pregnant women.
• In all these patients’ comprehensive clinical examination and appropriate imaging and bio-chemical evaluation was done.

Table: 1 Distribution Of Cases According To Age

Figure: Distribution Of Cases According To Age

In the present study it was observed that the mean age of the study population was 52.2±9.2, majority of patients i.e 43% were in the age group 40-49 yrs followed by 35% in the age group of 50-59 yrs.

Table:2 Distribution Of Cases According To Sex

Figure: Distribution Of Cases According To Sex

In the present study 59% patients were Males and 41% were females.

Table:3 Association of Age and Sex

Figure: Association of Age and Sex

Table: 4 Distribution of Cases according to BMI

Figure: Distribution Of Cases According To BMI

In the present Study it was observed that the mean BMI was 21.9±2.9, majority of patients 75% were having normal weight with BMI between 18.5-24.9 kg/m² followed by 18% patients having overweight with BMI 25-29.9.

Table: 5 Distribution of Cases according to Smoking

Figure: Distribution of Cases according to Smoking

In the present study ,74% patients were Non-Smokers and 26% patients were Smokers.

Table: 6 Distribution of Cases according to Family H/o

Figure: Distribution of Cases according to Family H/o

In the present study it was observed that 24% patients had family h/o Hypertension.

One of the most difficult medical conditions to manage globally is hypertension, which is also known to be the biggest risk factor for cardiovascular disease. Kidney disorders and hypertension are intimately associated. Microalbuminuria is a sign of preclinical illness that is asymptomatic and that occurs before severe morbid events. It is also a reflection of early kidney impairment. The heart is always under haemodynamic strain due to hypertension. The final outcome is left ventricular hypertrophy.It is the heart's way of adapting to systemic arterial hypertension. 100 newly diagnosed hypertensives in the over-20 age range participated in our study; 41% were female and 59% were male. The majority of the patients were between the ages of 40 and 50. Out of the 59 men, 26 were There was a substantial correlation between microalbuminuria and left ventricular hypertrophy in newly diagnosed hypertensives, as demonstrated by the presence of microalbuminuria in 70 (70%) patients, 39 of whom had left ventricular hypertrophy (55.7%), and 31 (44.3%) had normal cardiac geometry.

Individuals with wider pulse pressure had a higher incidence of left ventricular hypertrophy.LVH was seen in 2 patients and 4 patients with pulse pressure ranges of <40 and 41-50, respectively, whereas LVH was present in 6 out of 22 patients with pulse pressure in the range of 51–60 and 29 of 47 patients with pulse pressure >60. The majority of individuals with normal geometry were in the 41–50 and <40 pulse pressure ranges.

In our investigation, 70% of the patients had microalbuminuria. Microalbuminuria was observed to positively correlate with both left ventricular hypertrophy and hypertension stage. Taking office values into account, Pontemoli et al.'s MAGIC investigation found that the degree and prevalence of microalbuminuria correlated with the height of blood pressure, and this correlation was much stronger with 24-hour blood pressure In research by Poudyal et al., 40 (62.5%) of the hypertension patients tested positive for MAU. The frequency of MAU in our study was 69%, according to Raj et al.'s investigation on Microalbuminuria and its Correlation with Left Ventricular Hypertrophy and Retinopathy. whereby 21% of cases were female and 48% of cases were male. MAU negative patients made up 31% of the total, with 17% of cases being male and There were 14 female cases. In a research, Kartik et al. discovered that hypertensive individuals with LVH had a greater incidence of MAU (71.4%), and that this difference is statistically significant (P < 0.0001).

As part of the i-SEARCH (Survey for Evaluating micro albuminuria Routinely by Cardiologists in patients with Hypertension) study, which collected data from 40 cardiology centres with a population of 476 patients, a prevalence of 67.8% of proteinuria in patients with hypertension was reported in Morocco. It was discovered in our study that 41% of the patients had LVH. Studies by Cuspidi C et al. and Drayer et al. reported prevalence values of 36–41% and 48%, respectively, of living with hypothyroidism.

In the present study we evaluated the Prevalence of Microalbuminuria and Left ventricular hypertrophy in newly diagnosed hypertensive patients we found that: 43% were between age group of 40-49 Among 100 patients,41 patients had LVH and 59 had normal cardiac geometry Among 70 patients with microalbuminuria, 39 patients had Left ventricular hypertrophy showing a significant association between Microalbuminuria and Left ventricular hypertrophy. BMI did not have a statistically significant relation with Microalbuminuria and left ventricular hypertrophy. A significant association was seen between widened pulse pressure and left ventricular hypertrophy. Majority of patients with Pulse pressure above 50 had Left ventricular hypertrophy. A significant association was found between Stage of Hypertension with Microalbuminuria and left ventricular hypertrophy. Hence from the findings above and results we conclude that microalbuminuria is an integrated marker of CV risk and has a statistically significant association with Left ventricular hypertrophy.

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