Urine albumin/creatinine ratio and echocardiographic left ventricular structure and function in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. Losartan Intervention for Endpoint Reduction.
BACKGROUND
Albuminuria, reflecting systemic microvascular damage, and left ventricular (LV) geometric abnormalities have both been shown to predict increased cardiovascular morbidity and mortality. However, the relationship between these markers of cardiovascular damage has not been evaluated in a large hypertensive population.


METHODS
The urine albumin/creatinine ratio (UACR) and echocardiographic measures of LV structure and function were obtained in 833 patients with stage I to III hypertension and LV hypertrophy determined by electrocardiogram (ECG) (Cornell voltage-duration or Sokolow-Lyon voltage criteria) after 14 days of placebo treatment.


RESULTS
Patients' mean ages were 66 years, 42% were women, 23% had microalbuminuria, and 5% had macroalbuminuria. Patients with eccentric or concentric LV hypertrophy had higher prevalences of microalbuminuria (average 26%-30% vs 9%, P <.001) and macroalbuminuria (6%-7% vs <1%, P <.001). Furthermore, patients with microalbuminuria and macroalbuminuria had a significantly higher LV mass and lower endocardial and midwall fractional shortening. Patients with abnormal diastolic LV filling parameters had a significantly increased prevalence of microalbuminuria. In univariate analyses, UACR correlated positively to LV mass, systolic blood pressure, age (all P <.001) and pulse pressure/stroke volume and negatively to relative wall thickness (both P <.01) and endocardial (P <.05) and midwall shortening (P <.001) but not to diastolic filling parameters. In multiple regression analysis higher UACR was associated with higher LV mass (beta=.169, P <.001) independently of older age (beta =.095, P <.01), higher systolic pressure (beta=.163), black race (beta=.186), and diabetes (beta=.241, all P <.001).


CONCLUSIONS
In hypertensive patients with ECG LV hypertrophy, abnormal LV geometry and high LV mass are associated with high UACR independent of age, systolic blood pressure, diabetes, and race, suggesting parallel cardiac and microvascular damage.
Wachtell
Kristian
K
Laboratory of Cardiology, Department of Medicine, Copenhagen County University Hospital, Glostrup, Denmark. kristian@wachtell.net
Palmieri
Vittorio
V
Olsen
Michael H
MH
Bella
Jonathan N
JN
Aalto
Tapio
T
Dahlöf
Björn
B
Gerdts
Eva
E
Wright
Jackson T
JT
Papademetriou
Vasilios
V
Mogensen
Carl E
CE
Borch-Johnsen
Knut
K
Ibsen
Hans
H
Devereux
Richard B
RB
D000368:Aged; D000419:Albuminuria / Q000208:ethnology / Q000652:urine*; D000704:Analysis of Variance; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000208:ethnology / Q000652:urine*; D008297:Male; D011379:Prognosis; D012044:Regression Analysis; D013318:Stroke Volume; D014463:Ultrasonography
D003404:Creatinine