title: Accuracy of retinal changes in predicting microalbuminuria among elderly hypertensive patients: a cross-sectional study from a teaching hospital in South India.
abstract: OBJECTIVE
  Microalbuminuria is an important marker of end organ damage in hypertensive patients, but is often not tested for, especially in a resource-poor setting. We studied the accuracy of retinal changes in predicting microalbuminuria among a cohort of geriatric hypertensive patients.
  
  
  METHODS
  One hundred and eighty elderly hypertensive patients aged more than 65 years were assessed for their demographic characteristics, smoking status, duration of hypertension, current severity of hypertension, body mass index, left ventricular hypertrophy by electrocardiogram (ECG), and high sensitivity C-reactive protein (HsCRP). Optic fundi were assessed for retinopathy after pupillary dilatation, and were photographed. Microalbuminuria (albumin-creatinine ratio) was measured as an average of two nonconsecutive overnight spot urine samples. Patients with pre-diabetes, diabetes, metabolic syndrome, treatment with angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, overt nephropathy or proteinuria, and active infection were excluded.
  
  
  RESULTS
  Mean age was 74 +/- 6.56 years. One-third were obese and 18.9% had left ventricular hypertrophy. Prevalence of microalbuminuria was 39.4% and prevalence of retinopathy was 40%. Microalbuminuria showed a strong association with retinopathy (P < 0.0001). Logistic regression identified association of microalbuminuria with duration of hypertension (P = 0.001) and elevated high sensitivity C-reactive protein (P = 0.021). Retinopathy was associated with duration of hypertension (P = 0.001) and smoking (P < 0.0001). Tests of accuracy for retinopathy as a predictor of microalbuminuria showed a sensitivity of 72% and specificity of 81%.
  
  
  CONCLUSIONS
  Prevalence of microalbuminuria and retinopathy were quite high in our cohort of elderly hypertensive patients. Retinal changes of any grade probably have moderate accuracy in predicting microalbuminuria and hence we can initiate work-up for target organ damage, especially in a resource-poor setting.
authors.affiliation: Sri Ramachandra University, Porur, Chennai, Tamilnadu, India. drpssghanshyam@yahoo.co.in
authors.forename: Ghanshyam Palamaner Subash
authors.initials: GP
authors.lastname: Shantha
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bhaskar
authors.forename: Anita A
authors.initials: AA
authors.lastname: Kumar
authors.forename: Varun
authors.initials: V
authors.lastname: Sundaram
authors.forename: Arul
authors.initials: A
authors.lastname: Senghor
authors.forename: Porchelvan
authors.initials: P
authors.lastname: Swaminathan
authors.forename: Manjunath
authors.initials: M
authors.lastname: Sundaresan
authors.forename: Yadav
authors.initials: Y
authors.lastname: Srinivasan
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham