Pattern of occurrence of microalbuminuria among dippers and non-dippers (essential hypertensives) in a Nigerian university teaching hospital : cardiovascular topics
2004
Objectives : Hypertensives who fail to manifest the normal
circadian nocturnal fall in blood pressure have a
higher incidence of cardiovascular complications, early
glomerular injury and microalbuminuria. This study
aims to quantify the proportion of dippers and nondippers
among the essential hypertensive population,
and determine the frequency of occurrence of microalbuminuria
among them. Materials and methods : Early morning urine specimens
were taken from 50 patients with essential hypertension
and 20 healthy, normotensive subjects. Combined negative
results from albustic strip testing and sulfosalicylic
acid tests were taken as excluding microalbuminuria.
While collecting urine for 24-hour urinary protein and
creatinine clearance, hourly blood pressure readings
were recorded. Readings obtained between 07:00 and
23:00 were taken as daytime blood pressure readings,
whereas readings obtained between 23:00 and 07:00
were considered night-time blood pressures. Dippers
were considered to be those patients in whom the difference
between mean daytime systolic/diastolic blood
pressure and mean night-time systolic/diastolic blood
pressure was 10/5 mm Hg or more. Results : Thirty-six (72%) and 14 (28%) patients with
essential hypertension fulfilled the criteria for dippers
and non-dippers, respectively. The night-time systolic
and diastolic blood pressures were significantly higher
in non-dippers than in dippers (lIgPl/Ig < 0.05). The mean
daytime systolic and diastolic blood pressures were not
different between these two groups. Twenty-nine out
of 36 (80.6%) urinary specimens from dippers were
without microalbuminuria, against six out of 14 (42.9%)
specimens from non-dippers, lIgpl/Ig < 0.05. Eighteen out of
20 controls (90%) were without microalbuminuria. Conclusion : This study demonstrated that about 28%
of the local essential hypertensive population was nondippers
and 57.1% of these had microalbuminuria with
the attendant cardiovascular and renal risks.
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