Does Albuminuria Correlate With Silent Myocardial Ischemia And Delayed Heart Rate Recovery In Hypertensive Men Without Diabetes Mellitus ?
Abstract
Background: Silent myocardial ischemia (SMI) defined asmyocardial ischemiawithout anginal pain. SMI is frequently found in diabetes due to autonomic neuropathy, but in hypertension the involvement of autonomic neuropathy is still not known. Heart rate recovery(HRR) has been known as manifestation of autonomic neuropathy.The simple measurement of HRR is potential as screening tools for autonomic neuropathy. Nevertheless, SMI and delayed HRR are known as independent predictors for cardiovasluar mortality, hence emphasize the importance for early diagnosis. In diabetes, albuminuria has been proven to be an independent predictor for SMI and delayed HRR, but in hypertensive patients without diabetes the correlation is still unclear.Objectives: This study is aimed to determine the incidence of SMI, delayed HRR, and albuminuria in hypertensive patients without diabetes, the correlation between albuminuria and SMI and delayed HRR.
Methods: This is an observational study with cross-sectional approach. Fourty consecutive hypertensive without diabetes, history of chest pain, and known CAD. They underwent treadmill exercise testing with collection of spot urine before exercise to measure albumin urine to creatinine ratio (ACR). SMI and HRR to 3 minutes were then recorded.
Results: SMI was diagnosed in 15% patients. The incidence of delayed HRR in the first, second and third minute after peak exercise were 60%,80%, and52.5% respectively. Albuminuria was significantly associated with SMI (OR 13.889 (1.423 – 135.544), p = 0.014). There were no signification correlation between albuminuria and delayed HRR
Conclusion: Albuminuria is a good predictor for SMI in hypertensive patients.
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References
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15. Pringle SD, Dunn FG, Tweddel AC, Martin W, Macfarlane PW, McKillop JH, et al. Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy. Br Heart J 1992; 67(5): 377-382.
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20. Palatini P. Prevalence and clinical correlates of microalbuminuria in stage 1 hypertension. Results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST) study. Am J Hypertens 1996; 9: 334-341.
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22. Rodicio JL, Campo C, Ruilope LM. Microalbuminuria in essential hypertension. Kidney International 1998; 54: S51-4
2. Lawes CM, Bennett DA, Rodgers A. Blood pressure and coronary heart disease: a review of the evidence. Semin Vasc Med 2002; 2(4): 355-68.
3. Boon D, Piek JJ, Montfrans GA. Silent ischemia and hypertension. Journal of Hypertension 2000; 18(10): 1355-1364.
4. Boras J, Brkljacic N, Ljubicic A, Ljubic S. Silent ischemia and diabetes mellitus. Diabetologia Croatia 2010; 39(2): 57-65.
5. Ayad F, Belhadj M, Paries J, Attali JR, Valensi P. Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications. Diabet Med 2010; 27(7): 804-811
6. Sacre JW, Jellis CL, Coombes JS, Marwick TH. Diagnostic accuracy of heart-rate recovery after exercise in the assessment of diabetic autonomic neuropathy. Diabet Med 2012; 29(9): e312-320.
7. Yamada T, Yoshitama T, Makino K, Lee T, Saeki F. Heart rate recovery after exercise is a predictor of silent myocardial ischemia in patients with type 2 diabetes. Diabetes Care 2011; 34: 724-6.
8. Polonia J, Amaral C, Bertoquini S, Martins L. Attenuation of heart rate recovery after exercise in hypertensive patients with blunting of the nighttime blood pressure fall. Int J Cardiol 2006; 106(2): 238-43.
9. Rutter MK, Wahid ST, McComb JM, Marshall SM. Significance of Silent ischemia and microalbuminuria in predicting coronary events in asymptomatic patients with type 2 diabetes. JACC 2002; 40(1): 56-61.
10. Beijers H, Ferreira I, Stehouwer C. Microalbuminuria and cardiovascular autonomic dysfunction are independently associated with cardiovascular mortality : Evidence for distinct pathway. Diabetes Care 2009; 32(9): 1698-1703.
11. Bianchi S, Bigazzi R, Amoroso A, Campese VM. Silent ischemia is more prevalent among hypertensive patients with microalbuminuria and salt sensitivity. Journal of Human Hypertension 2003; 17: 13-20.
12. Gansevoort RT, Verhave JC, Hillege HL, et al. The validity of screening based on spot morning urine samples to detect subjects with microalbuminuria in the general population. Kidney International 2005; 67(94): S28-S35.
13. Cameron NE, Cotter MA. Metabolic and vascular factors in the pathogenesis of diabetic neuropathy. Diabetes 1997; 46(2): S31-S37.
14. Massie BM, Szlachcic Y, Tubau JF, O’Kelly BF, Mmon S, Chin W. Scintigraphic and electrocardiographic evidence of silent coronary artery disease in asymptomatic hypertension : A case-control study. JACC 1993; 22(6): 1598-1606.
15. Pringle SD, Dunn FG, Tweddel AC, Martin W, Macfarlane PW, McKillop JH, et al. Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy. Br Heart J 1992; 67(5): 377-382.
16. Best SA, Bivens TB, Palmer MD, Boyd KN, Galbreath MM, Okada Y, et al. Heart rate recovery after maximal exercise is blunted in hypertensive seniors. J Appl Physiol 2014; 117(11): 1302-7.
17. Cheng YJ, Lauer MS, Earnest CP, et al. Heart rate recovery following maximal exercise testing as a predictor of cardiovascular disease and all cause mortality in men with diabetes. Diabetes Care 2003; 26: 2052-2057.
18. Hadley DM, Dewey FE, Freeman JV, Myers JN, Froelicher VF. Prediction of cardiovascular death using a novel heart rate recovery parameter. Med Sci Sports Exerc 2008; 40(6): 1072-9
19. Watanabe J, Thamilarasan M, Blackstone EH, Thomas JD, Lauer MS. Heart rate recovery immediately after treadmil exercise and left ventricular systolic dysfunction as predictors of mortality. Circulation 2001; 104: 1911-1916.
20. Palatini P. Prevalence and clinical correlates of microalbuminuria in stage 1 hypertension. Results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST) study. Am J Hypertens 1996; 9: 334-341.
21. Marin R, Rodriguez P, Tranche S, Redon J, Morales-Olivas F, Galgo A, et al. Prevalence of abnormal urinary albumin excretion rate in hypertensive patients with impaired fasting glucose and its association with cardiovascular disease. J Am Soc Nephrol 2006. 17(12 suppl 3): S178-88
22. Rodicio JL, Campo C, Ruilope LM. Microalbuminuria in essential hypertension. Kidney International 1998; 54: S51-4
Published
2015-12-04
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How to Cite
Winata, J., Panda, A. L., & Azis, R. A. (2015). Does Albuminuria Correlate With Silent Myocardial Ischemia And Delayed Heart Rate Recovery In Hypertensive Men Without Diabetes Mellitus ?. Indonesian Journal of Cardiology, 36(1), 14-21. https://doi.org/10.30701/ijc.v36i1.436
Section
Clinical Research
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