Left ventricular mass assessed by electrocardiography and albumin excretion rate as a continuum in untreated essential hypertension.

OBJECTIVE: To study an association between albumin excretion rate and left ventricular mass (LVM) determined by electrocardiogram (ECG)-based criteria, and with respect to ambulatory blood pressure, in patients with newly diagnosed and never-treated essential hypertension. METHODS: We measured 24 h ambulatory blood pressure, albumin excretion rate and LVM in 74 patients with newly diagnosed (within the past year) and never-treated essential hypertension, who were admitted to the hypertension clinic (Ulleval University Hospital). Albumin excretion rate was evaluated by determination of the albumin:creatinine ratio in the first-voided morning urine sample. LVM was assessed by ECG using Cornell voltage-QRS duration product and Sokolow- Lyon criteria. RESULTS: Albumin excretion rate was significantly related to ambulatory blood pressure. There was a weak but significant negative correlation between the decrease in diastolic blood pressure during the night and the rate of excretion of albumin. The patients classified as dippers had a significantly lower albumin excretion rate compared with the non-dippers (1.36+/-0.83 compared with 1.68+/-0.87 mg/mmol; P = 0.03). LVM was found to be significantly related to ambulatory blood pressure. A weak relationship was observed between albumin excretion rate and LVM as evaluated by Cornell criterion (r = 0.23, P = 0.045). When only normoalbuminuric patients were included (i.e. four patients with microalbuminuria were excluded), the relationship was stronger (r = 0.36, P = 0.002). CONCLUSIONS: The present findings show a continuous relationship between albumin excretion rate, LVM and ambulatory blood pressure in newly diagnosed patients with essential hypertension, and suggest the occurrence of early effects on target organs (kidneys and heart). These associations were observed using easily applicable methods such as ECG monitoring and determination of the albumin:creatinine ratio in morning urine samples.

[The state of microcirculation during use of long acting metoprolol]. / beta-Adrenoblokatory i perifericheskii krovotok.

The aim of the study was to assess the effect of prolonged action metoprolol on the microcirculation in patients with essential hypertension (EH). We studied 51 patients with EH aged 53,4+/-4,5 years. After 7-10 days of "wash-out" period and after 8 weeks of prolonged action metoprolol (betaloc ZOK) the state of microcirculation was investigated with the use of laser Doppler flux-metry (LDF). We found significant decrease in basically enlarged basal blood flow and the level of sympathetic activity, increase in the amplitude of cardiodependent waves, normalization of basal blood flow decrement in postural test, increase in capillary blood flow reserve in patients with stage I-II EH. We failed to observe any significant changes in the microcirculatory parameters in patients with stage III EH. Treatment with prolonged action metoprolol led to increase in the number of patients with normocirculatory type of microcirculation primarily due to the decrease in the prevalence of hyperemic type. We conclude that prolonged action metoprolol does not alter microcirculation in patients with EF. Moreover, at the early stages of EH it improves the functional state of peripheral hemodynamics due to suppression of sympathetic activity.

[24-hour blood pressure monitoring and albumin excretion in urine in hypertension]. / 24-timersblodtrykk og albuminutskilling i urin ved høyt blodtrykk.

BACKGROUND AND OBJECTIVES: Microalbuminuria, a subclinical increase of albumin excretion in urine, is a novel recognized risk factor for atherosclerosis in essential hypertension. This study aimed to look at the association between ambulatory blood pressure and urinary albumin excretion (UAE) in hypertensive subjects. MATERIAL AND METHODS: 140 patients aged 50.1 +/- 11.6 years, referred for 24-hour ambulatory blood pressure monitoring (ABPM), were studied. A separate analysis was performed in 46 persons with newly diagnosed and untreated essential hypertension. Albumin excretion was evaluated by determining the albumin/creatinine ratio (ACR) in the first voided morning urine sample. According to the ACR, patients were categorized as having normoalbuminuria (ACR < 1.5 mg/mmol), borderline microalbuminuria (1.5 < or = ACR < 3.0 mg/mmol) and overt microalbuminuria (ACR > or = 3.0 mg/mmol). RESULTS: ACR was significantly higher in hypertensive than in normotensive individuals (2.17 +/- 2.67 and 1.72 +/- 2.97 mg/mmol respectively, p = 0.012). Average 24-hour, daytime and nighttime systolic as well as diastolic blood pressures were lower in patients with normoalbuminuria than in the other two groups and did not differ among the two microalbuminuric groups. A close relationship between ACR and ambulatory BP was observed, even for the subgroup of newly diagnosed and untreated hypertensive patients. INTERPRETATION: A close relationship is observed between ambulatory blood pressures and albumin excretion rates in the microalbuminuric and normoalbuminuric range. Further studies are needed to assess the threshold level of ACR when screening for microalbuminuria in hypertensive patients.