UACR: A novel risk marker for early detection of Atherosclerotic cardiovascular disease

Background: Hypertension is leading and modifiable risk factor for cardiovascular diseases and all-cause mortality. Left ventricular hypertrophy, seen in hypertensive patients is a strong predictor of unfavourable cardiovascular events. Microalbuminuria is considered as principal predictor of cardiovascular complications and mortality. Our study aims at finding prevalence of increased urine albumin creatinine ratio and left ventricular mass index in newly diagnosed hypertensive patients and finding a correlation among them.

Methodology: A hospital based cross sectional study was done. Adult patients visiting hospital OPD were screened for primary hypertension as per AHA (2017) guidelines and 40 were included in study. All patients underwent relevant blood and urine investigations. Urine albumin creatinine ratio was calculated in spot urine sample and left ventricular mass index was calculated using 2-D echocardiography.

Result: This study demonstrated that 70% newly diagnosed hypertensive patients had raised urine albumin creatinine ratio and 75% had raised left ventricular mass index. The data was plotted on scatter plot, which depicted the correlation between LVMI (g/m²) and UACR (mg/g). Non-parametric tests (Spearman Correlation) were used to explore the correlation between the two variables and strong positive correlation was found between LVMI (g/m²) and UACR (mg/g), and this correlation was statistically significant (rho = 0.74, p = <0.001). It has been found that for every 1 unit increase in LVMI (g/m²), the UACR (mg/g) increases by 2.58 units. Conversely, for every 1 unit increase in UACR (mg/g), the LVMI (g/m²) increases by 0.05 units.

Conclusion: This study demonstrated the presence of microalbuminuria and evidence of left ventricular hypertrophy in a significant number of newly detected and untreated patients of essential hypertension. Also, there is significant association between LVMI and UACR (microalbuminuria) in hypertensive patients. Hence, we can recommend microalbuminuria as a screening tool for Left Ventricular Hypertrophy in newly diagnosed hypertensive patients so as to detect risk for cardiovascular events early and select our treatment strategy accordingly.