title: ADMA, C-reactive protein, and albuminuria in untreated essential hypertension: a cross-sectional study.
abstract: BACKGROUND
  Asymmetric dimethylarginine (ADMA) and subclinical inflammation are associated with atherosclerosis progression, whereas microalbuminuria is an established index of hypertensive organ damage.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  In an outpatient hypertensive unit, 296 nondiabetic and untreated participants with hypertension were studied. Participants with atherosclerotic cardiovascular disease, severe valvulopathy, congestive heart failure, presence of neoplastic or other concurrent systemic disease, atrial fibrillation, serum creatinine level > 1.5 mg/dL in men and > 1.4 mg/dL in women, and urinary albumin excretion > 300 mg/24 h were excluded.
  
  
  METHODS
  ADMA and high-sensitivity C-reactive protein (hs-CRP) levels.
  
  
  METHODS
  Albuminuria assessed using albumin-creatinine ratio (ACR).
  
  
  METHODS
  Participants underwent ambulatory blood pressure monitoring, echocardiography, routine assessment of metabolic profile, ADMA, and hs-CRP, whereas ACR was determined as the mean of 3 values in nonconsecutive morning spot urine samples.
  
  
  RESULTS
  64 participants had an ACR of 30-300 mg/g. Stratification based on ADMA level showed that participants with hypertension in quartile [Q] 4 compared with those in Q3, Q2, and Q1 showed the highest ACRs (53.2 vs 31.2 vs 30.4 vs 16.7 mg/g; P < 0.008 for all). Moreover, stratification based on hs-CRP level showed that participants with hypertension in Q4 (69.8% had microalbuminuria) showed the highest ACRs (72.2 vs 25.6, 16.2, and 19.2 mg/g for Q3, Q2, and Q1, respectively; P < 0.008 for all). Stepwise regression analysis showed that age, 24-hour systolic blood pressure, hs-CRP level, ADMA level, and the interaction of hs-CRP with ADMA were independent predictors of ACR (R(2) = 0.674; P < 0.001).
  
  
  CONCLUSIONS
  Cross-sectional study.
  
  
  CONCLUSIONS
  In patients with untreated essential hypertension, increased hs-CRP and ADMA levels are associated with microalbuminuria, suggesting the involvement of inflammation and endothelial dysfunction in vascular and kidney damage.
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece. ktsioufis@hippocratio.gr
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Dimitriadis
authors.forename: Eirini
authors.initials: E
authors.lastname: Andrikou
authors.forename: Costas
authors.initials: C
authors.lastname: Thomopoulos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.forename: Elli
authors.initials: E
authors.lastname: Stefanadi
authors.forename: Costas
authors.initials: C
authors.lastname: Mihas
authors.forename: Antigoni
authors.initials: A
authors.lastname: Miliou
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000378:metabolism* / Q000503:physiopathology; D001120:Arginine / Q000031:analogs & derivatives* / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002097:C-Reactive Protein / Q000378:metabolism*; D003404:Creatinine / Q000378:metabolism; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000378:metabolism* / Q000503:physiopathology; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D012709:Serum Albumin; C018524:N,N-dimethylarginine; D002097:C-Reactive Protein; D001120:Arginine; D003404:Creatinine