Objective: Microalbuminuria (MA) is known to predict the onset of clinical proteinuria and chronic renal failure in diabetes mellitus. More recently, MA has been found to be an independent risk factor for cardiovascular disease in non diabetic populations. The present study was designed to investigate the prevalence of microalbuminuria and factors that associate with urine excretion of albumin in the population of Blida. Design and method: 2920 Participants in our specialized consultation were enrolled in this study. Besides the routine checkup program (an interview regarding health status, physical examination, chest X-ray, electrocardiography, and laboratory assessment of cardiovascular risk factors). For MA, spot urine samples were collected in the early morning and microalbuminuria was defined as, a urinary albumin excretion between 30 and 300 mg/l. These patients also underwent determination of ambulatory blood pressure monitoring. All calculations and statistical analyzes are processed by the SPSS 17.0. Results: The prevalence of MA in hypertensive population was 32%.The blood pressure of participants was 138 ± 16/78 ± 13 mmHg and 39.8% and 14.1% of participants were with hypertension and diabetes mellitus, respectively. Urine albumin was detected in 40.1% of cases. Mean age of 59.71 ± 13.56 years. Body mass index was > 30 kg/m2 in 58.2% of cases. Prevalence of Hyperglycemia was 23% with MA> 30 mg/l. Multivariate regression analysis revealed that abnormal albuminuria was correlated with systolic blood pressure, estimated 24 hours urinary salt excretion, and fasting plasma glucose after adjustment for possible factors (p < 0.0001). Conclusions: The prevalence of microalbuminuria increases with increase in age, body mass index and duration of hypertension. From this study, it is conceived that MA can be used as a predictor of future cardiovascular events in hypertensive patients.
A better understanding of the interrelationships between the structure and function of the large arteries would lead to optimize cardiovascular disease prevention strategies. In this study, we investigated the relationships of aortic arterial stiffness assessed by carotid-femoral pulse-wave velocity (PWV), with carotid plaque echogenicity assessed by B-mode ultrasound. We analyzed 561 subjects (without coronary heart disease or stroke) who were volunteers for free health examinations (age, 58.3+/-10.8 years; 32.6% women). Extracranial carotid plaque echogenicity was graded from 1 (plaque appearing black or almost black) to 4 (plaque appearing white or almost white) according to the Gray-Weale classification. Plaques of grades 1 and 2 were defined as echolucent plaques, and plaques of grades 3 and 4 were defined as echogenic plaques. Fifty-one subjects (9.1%) had echolucent carotid plaques, 109 (19.4%) had echogenic plaques, and 401 (71.5%) had no plaques. Subjects with echogenic plaques had higher PWV mean (12.9+/-2.8 m/s) compared with those without plaques (11.1+/-2.3 m/s, P<0.001) and compared with those with echolucent plaques (11.3+/-2.3 m/s, P<0.01). The PWV means in subjects without plaques and those with echolucent plaques were similar and not statistically different (P=0.55). When multivariate adjustment for major known cardiovascular risk factors was performed, these results were not markedly modified. Similar patterns of results were also observed in many subgroups according to age, gender, and hypertensive status. This study provides the first evidence that echogenic but not echolucent carotid plaques are associated with aortic arterial stiffness. This association applies to individuals with normal blood pressure and those with elevated blood pressure. Assessment of the joint and interaction effects of plaque morphology and arterial stiffness on the occurrence of cardiovascular events would permit a better identification of high-risk subjects.
Objective: The aim of the study is to investigate the prevalence of resistant hypertension in specialized consultation in the area of Blida (Algeria), to assess the causes of resistant hypertension and clinical parameters characterizing this condition. Design and method: A total of 2175 hypertensive patients treated of both sexes were included (1158 females and 1017 males) with a mean age of 49.71 ± 13.56 years, examined between June 2012-june 2014. The control consisted of filling a questionnaire oriented on civil status, medical history, anthropometric parameters, and routine blood exams were collected. Resistant hypertension was identified according to the following criteria: office blood pressure that remains above goal in spite of the concurrent use of 3 antihypertensive agents of different classes, including a diuretic, at full dose. All calculations and statistical analyzes are processed by the SPSS 17.0. Results: 413 patients (19%) resulted to be resistant to antihypertensive treatment. Among resistant hypertensive patients the following conditions were significantly more represented: older age (65.7 ± 12.6 vs 57.7 ± 13.4 years, p < 0.001), sedentary status (87.1 vs 74.5% p < 0.05), previous cardiovascular events (36.9 vs 17.7%, p < 0.001), diabetes (41.8 vs 26.5%, p < 0.001), hypercholesterolemia (20.8 vs 11.4%, p < 0.05), obesity (35.5 vs 16.3%, p < 0.0001), metabolic syndrome (48.2 vs 22.6%, p < 0.03), chronic kidney disease (24.9 vs 14.1%, p < 0.05). In a logistic regression model adjusted for confounders, only metabolic syndrome and diabetes mellitus (p = 0.002) were associated to an increased probability to have resistant hypertension. Conclusions: All classical cardiovascular risk factors were more frequent in resistant hypertensive patients; only metabolic syndrome and diabetes mellitus were independently associated with this condition.
Objective It has been suggested that non-invasive aortic stiffness measurements can be used as an indicator of atherosclerosis. The relationships of arterial stiffness with arterial wall hypertrophy and atherosclerosis however, have rarely been investigated in large-scale studies. The present study reports the associations of carotid arterial structure assessed by B-mode ultrasound with carotid-femoral pulse-wave velocity in hypertensive and non-hypertensive subjects. Design and methods Free health examinations were performed on 564 subjects (age 58.2 ± 10.8 years, 31.9% of women, 53.2% of all were hypertensive). Carotid–femoral pulse-wave velocity (PWV) was used to assess aortic stiffness. Carotid ultrasound examination included measurements (at sites free of plaques) of intima–media thickness (IMT) at the common carotid arteries (CCA), CCA-lumen diameter, and assessment of atherosclerotic plaques in the extracranial carotid arteries. Results Subjects with carotid plaques had significantly higher mean sex-adjusted values of PWV than those without carotid plaques (12.7 ± 0.2 versus 11.1 ± 0.1 m/s, P< 0.001). Multivariate analyses showed that this association was independent of sex, age, height, body mass index, mean blood pressure, pulse pressure, diabetes, hypercholesterolaemia and smoking habits (P< 0.009). PWV was positively associated with CCA-IMT and CCA-lumen diameter in sex-adjusted analysis (partial correlation coefficients (r) were respectively 0.39 and 0.42, P< 0.001 for each). However, the association of PWV with CCA-IMT, but not that with CCA-lumen diameter, disappeared after further adjustment for age and blood pressure measurements (mean blood pressure and/or pulse pressure). Conclusion This study shows that there is a differential association of PWV with CCA-IMT and carotid plaques. The nature of the independent positive association between atherosclerosis and arterial stiffness should be thoroughly investigated.
Background and objectives: Cardiovascular disease is the main cause of mortality in chronic kidney disease (CKD) patients. Vitamin D might have beneficial effects on vascular health. The aim of this study was to determine the prevalence of vitamin D deficiency (25-hydroxyvitamin D [25D] ≤ 15 ng/ml) and insufficiency (25D levels between 16 and 30 ng/ml) in a cohort of patients at different CKD stages and the relationships between vitamin D serum levels, vascular calcification and stiffness, and the mortality risk. Design, setting, participants & measurements: One hundred forty CKD patients (85 men, mean age 67 ± 12 yr; CKD stages 2 [8%], 3 [26%], 4 [26%], 5 [7%], and 5D [(33%]) were allocated for a prospective study. Serum levels of 25D and 1,25-dihydroxyvitamin D, aortic calcification score, and pulse wave velocity (PWV) were evaluated. Results: There was a high prevalence of vitamin D deficiency (42%) and insufficiency (34%). Patients with 25D ≤ 16.7 ng/ml (median) had a significantly lower survival rate than patients with 25D >16.7 ng/ml (mean follow-up, 605 ± 217 d; range, 10 to 889; P = 0.05). Multivariate adjustments (included age, gender, diabetes, arterial pressure, CKD stage, phosphate, albumin, hemoglobin, aortic calcification score and PWV) confirmed 25D level as an independent predictor of all-cause mortality. Conclusions: Vitamin D deficiency and insufficiency were highly prevalent in this CKD cohort. Low 25D levels affected mortality independently of vascular calcification and stiffness, suggesting that 25D may influence survival in CKD patients via additional pathways that need to be further explored.
