title: Independent association of ECG abnormalities with   microalbuminuria and renal damage in hypertensive   patients without overt cardiovascular disease: data from   Italy-Developing Education and awareness on   MicroAlbuminuria in patients with hypertensive   Disease study.
abstract: OBJECTIVE
  Renal abnormalities are strongly associated with cardiac damage in essential hypertension. Detection of preclinical cardiac and renal abnormalities is a key clinical step in hypertension management. This study investigated the relationship between ECG abnormalities and microalbuminuria (MAU) in hypertensive patients without overt cardiovascular disease. This relationship, in fact, has never been extensively studied.
  
  
  METHODS
  The study population was that of Italy-Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease, a large observational study including 4121 hypertensive patients in Italy. Patients with overt cardiovascular diseases were excluded from the present analysis. ECGs were centrally read and urinary albumin/creatinine ratio was carefully assessed. Chronic kidney disease was defined by the presence of albuminuria or by a reduction of glomerular filtration rate.
  
  
  RESULTS
  The presence of ECG abnormalities was significantly and directly associated with chronic kidney disease [odds ratio (OR) 1.66, 95% confidence interval (CI) 1.32-2.07, P<0.001], particularly with MAU (OR 1.81, 95% CI 1.39-2.36, P<0.001). Main selected ECG abnormalities were also significantly associated with MAU [rhythm abnormalities (OR 2.94, 95% CI 1.77-4.88, P<0.001), intraventricular conduction defects (OR 1.95, 95% CI 1.32- 2.87, P<0.01), ventricular repolarization alterations (OR 1.84, 95% CI 1.26-2.70, P<0.01) and left-axis deviation (OR 1.87, 95% CI 1.26-2.79, P<0.01)]. After adjustment for confounders, an abnormal ECG and all the main ECG abnormalities remained significantly associated with MAU.
  
  
  CONCLUSIONS
  This is the first large and systematic analysis of the relationship between detailed ECG abnormalities and MAU/chronic kidney disease in hypertensive patients without overt cardiovascular diseases. We report a significant and independent relationship between the presence of ECG abnormalities and renal damage in a preclinical stage of hypertension. Identification of ECG abnormalities in hypertension should prompt physicians to careful detection for renal damage, also in order to achieve an accurate risk stratification.
authors.affiliation: Second School of Medicine, University of Rome Sapienza, S.Andrea Hospital, Rome, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Sciarretta
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
authors.forename: Enrico Agabiti
authors.initials: EA
authors.lastname: Rosei
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
authors.forename: Vittorio
authors.initials: V
authors.lastname: Costa
authors.forename: Gastone
authors.initials: G
authors.lastname: Leonetti
authors.forename: Achille Cesare
authors.initials: AC
authors.lastname: Pessina
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Valentina
authors.initials: V
authors.lastname: Francione
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.forename: Maria Beatrice
authors.initials: MB
authors.lastname: Musumeci
authors.forename: Luca
authors.initials: L
authors.lastname: De Siati
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrucci
authors.forename: Giacomo
authors.initials: G
authors.lastname: Deferrari
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*