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The prevalence and significance of microalbuminuria in hypertensive patients with impaired fasting glucose (IFG) has received very little attention. A total of 10,320 hypertensive patients who attended primary care centers were enrolled in this study, and the final analysis was done in 7625 patients: 1459 without IFG (plasma glucose <100 mg/dl), 3010 with IFG (plasma glucose > or =100 mg/dl and <126 mg/dl), and 3156 with type 2 diabetes (plasma glucose >126 mg/dl). Microalbuminuria was determined using the Micro Albustix reactive strip from Bayer (high urinary albumin excretion [UAE]: Albumin/creatinine ratio > or =3.4 mg/mmol). The proportion of patients with high UAE was 39.4, 48.3, and 65.6%, respectively, in the three groups (P < 0.01 for the trend). The differences in UAE between the group with IFG and the group with normal fasting glucose persisted after adjustment for age, gender, systolic BP, fasting plasma glucose, and cardiovascular comorbidity (odds ratio 1.74; 95% confidence interval 1.08 to 2.80). Hypertensive patients with IFG and high UAE showed a higher prevalence of ischemic heart disease, cardiac insufficiency, left ventricular hypertrophy, atrial fibrillation, and renal insufficiency than the group with normal UAE. Global prevalence of cardiovascular conditions was 30.4% in the group with high UAE compared with 21.4% in the group with normal UAE (odds ratio 1.60; 95% confidence interval 1.31 to 1.95). It is concluded that almost half of hypertensive patients with IFG have high UAE and a higher prevalence of associated cardiovascular involvement and renal insufficiency.

Objective: To assess the relationship between microalbuminuria and oxidative stress in mononuclear peripherals cells in essential hypertension., Methods: A total of 123 hypertensive patients in absence of antihypertensive treatment were included. A 24-h ambulatory blood pressure (BP) monitoring was performed using a Spacelabs 90207 monitor, and microalbuminuria was measured in 24-h urine collections. Oxidized/reduced glutathione ratio and the content of malondialdehide and damaged base 8-oxo-2'-deoxyguanosine in genomic and mitochondrial DNA were measured in peripheral mononuclear cells., Results: In the 29 (24%) microalbuminuric subjects, the amount of reduced glutathione was significantly lower and the ratio oxidized/reduced glutathione was significantly higher than in the normoalbuminuric subjects. In contrast, the simultaneous measurement of the levels of malondialdehide and 8-oxo-2'-deoxyguanosine from both genomic and mitochondrial DNA oxidation did not achieve statistical significance between the two groups. Subjects with the highest oxidized/reduced glutathione ratio tertile showed the highest urinary albumin excretion (UAE) (P = 0.04 for trend). In a stepwise multiple regression analysis, oxidized/reduced glutathione ratio was the main significant determinant of UAE accounting for the 9% of the variance when 24-h mean BP, age, sex, body mass index, glucose and total cholesterol were included in the model., Conclusions: Oxidative stress seems to be a determinant of UAE independent of BP levels even in hypertensive subjects.

Background: The value of nocturnal minute-by-minute urine was analyzed for the detection of microalbuminuria in high blood pressure., Methods: Urinary albumin excretion (UAE) was measured by immunonephelometry in 70 patients with essential arterial hypertension (34 males, mean age 44 +/- 5 years, body mass index [BMI] 28 +/- 4, clinical blood pressure [BP] 157 +/- 12/97 +/- 7 mmHg) and 12 healthy normotensive controls (5 males, mean age 38 +/- 4 years, BMI 27 +/- 3; clinical BP 126 +/- 12/79 +/- 5 mmHg). Both 24 hours urine as well as nocturnal urine were collected over 2 days. The intraindividual variability was evaluated by calculation of the intraclass correlation coefficient and by the Bland and Altman method., Results: Mean 24-hour UAE was 24.7 +/- 41.9 micrograms/min, greater than nocturnal urine (17.7 +/- 32.8 micrograms/min) (p < 0.05). The UAE rate was significantly greater in the hypertensive patients than in the controls (p < 0.01) for both the 24-hour and nocturnal urine. The intraindividual variability estimated as the percentage of repeatability was 35% for 24-hour UAE and 43% for nocturnal UAE, being slightly higher values than those observed in the controls. Microalbuminuria was detected in 17 (24%) of the patients in 24-hour samples while in the nocturnal urine 12.12 or 10 patients were found according to whether the threshold considered was 14 micrograms/min, 14.9 micrograms/min or 20 micrograms/min, respectively. While the specificity in nocturnal minute-by-minute urine was 98% and the positive predictive value was 0.91 for any of the thresholds considered, sensitivity ranged from 59% for the higher threshold (20 micrograms/min) to 70% for the lower threshold (14 micrograms/min)., Conclusions: The determination of microalbuminuria in minuted nocturnal urine in patients with essential arterial hypertension is less sensitive than that determined in 24-hour urine.

Background: The occurrence of microalbuminuria (mAlb) in essential hypertension (HT) was evaluated., Methods: 100 patients were studied (56 males), with mean age 39 +/- 6 years, body mass index (BMI) 28 +/- 4. 32 had borderline HT, 47 had mild HT and 21 had moderate HT. 74 were in stage I of the WHO and 26 were in stage II. All had normal renal function (creatinine 91 +/- 12 mumol, Clcr 92 +/- 13 ml/m/1.73 m2) and no proteinuria as measured by sulphosalicylic acid. mAlb was immuno-nephelometrically measured in two 24-hour urine samples, and was given as urinary albumin excretion (UAE). In 62 patients, noninvasive ambulatory recording of blood pressure (NIAR) was carried out. In 39, ventricular mass was estimated by echocardiography., Results: UAE was correlated with SPB24h (r = 0.39) and DBP24h, but not with SBP or DBP. UAE was greater in patients with moderate HT than in those with mild or borderline HT (p less than 0.01). UAE was less than 20 mg/24 h in 70 patients (group A) and greater than 20 mg/24 h in 30 (group B). The comparative analysis of the two groups showed different clinical BP values (SBP p less than 0.01; DBP p less than 0.001) and NIAR (SBP 24 h p less than 0.001; DBP 24 h p less than 0.05). In the 47 patients with mild HT the only differential parameter between groups A and B was SBP24h (p less than 0.05). Regarding echocardiographic data, in higher UAE levels a greater left ventricular mass index was found in males (chi-square p less than 0.05)., Conclusions: Increased mAlb is associated with more severe HT. This finding may be helpful for the initial evaluation of hypertensive patients.