Blood pressure load, vascular permeability and target organ damage in primary hypertension.
BACKGROUND
Target organ damage (TOD) is an often reversible subclinical condition that may precede major cardiovascular events in primary hypertensive patients. Furthermore, TOD has been shown to be a complex, multifactorial process which does not depend on blood pressure (BP) reduction alone. We therefore investigated the relationship between BP load, vascular permeability and the occurrence of TOD.


METHODS
Thirty-seven never-treated, nondiabetic hypertensive patients were enrolled. Albuminuria was measured as the albumin to creatinine ratio (ACR), left ventricular mass index (LVMI) was assessed by echocardiography, systemic vascular permeability was evaluated by transcapillary escape rate of albumin (TERalb), and BP was measured by means of 24-hour ambulatory BP monitoring.


RESULTS
Patients with microalbuminuria showed higher levels of body mass index (BMI) (p<0.034), 24-hour systolic BP levels (p<0.001), left ventricular mass index (LVMI) (p=0.003) and capillary permeability to albumin (p<0.005), as compared with normoalbuminurics. Increased BP load and vascular permeability were associated with higher LVMI (p=0.012) and with an increased risk of having microalbuminuria and/or left ventricular hypertrophy (Chi square=17.4; p<0.001). Logistic regression analysis showed that the risk of having at least 1 sign of TOD was 10-fold higher in patients with TERalb above the median, and almost 5-fold higher for each 10 mm Hg increase in systolic blood pressure.


CONCLUSIONS
Abnormal vascular permeability and increased BP load are potentially modifiable risk factors that are independently associated with the development of subclinical cardiac and renal damage.
Department of Internal Medicine and Cardionephrology, Azienda Universitaria Ospedale San Martino, University of Genoa, Genoa - Italy.
Valeria
V
Falqui
Francesca
F
Viazzi
Giovanna
G
Leoncini
Elena
E
Ratto
Angelica
A
Parodi
Novella
N
Conti
Cinzia
C
Tomolillo
Giacomo
G
Deferrari
Roberto
R
Pontremoli
D000328:Adult; D000419:Albuminuria / Q000175:diagnosis; D001794:Blood Pressure; D002199:Capillary Permeability; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged