Excreção urinaria de proteinas em pacientes hipertensos e sua correlação com hipertrofia ventricular esquerda e monitoramento ambulatorial da pressão arterial

O perfil de excreção urinária de proteínas e sua correlação com Hipertrofia Ventricular Esquerda (HVE) e a Monitorização Ambulatorial da Pressão Arterial de 24h (MAPA) foi avaliado em 53 pacientes adultos com hipertensão arterial sistêmica (HAS) divididos em Grupo I (HAS em uso de medicação, n=30) e Grupo II (HAS recém diagnosticada, sem medicação, n= 23). Amostras isoladas de sangue e urina foram coletadas e submetidas às determinações urinárias das relações proteína/creatinina (PROT/CREA); microalbumina/creatinina (MA/CREA) e alfa-1-microglobulina/creatinina (A1M/CREA) e às determinações séricas de colesterol (total e frações), triglicérides, glicose e creatinina. No Grupo I alterações qualitativas na excreção de proteínas urinárias foram observadas em 29% dos pacientes e em 17% dos pacientes do grupo II. A MA foi a principal proteína excretada (23% Grupo I e 13% Grupo II) e a A1M esteve presente em ambos os grupos (6% Grupo I e 4% Grupo II). Dislipidemia foi observada em 70% dos pacientes de ambos os grupos. A análise estatística revelou não haver diferença significativa entre os grupos em relação aos níveis de MA e de A1M. A prevalência da HVE foi de 66% no Grupo I e 29% no Grupo II. A pressão diastólica ambulatorial noturna e a carga pressórica diastólica foram maiores no Grupo I. Neste grupo observou-se também uma correlação positiva entre HVE e microalbuminúria e entre LDL-colesterol e microalbuminúria. No Grupo II, diferenças significativas foram observadas entre pacientes com e sem HVE na média sistólica das 24h e na carga pressórica sistólica também das 24h. Nossos dados confirmam observações anteriores quanto a relação entre microalbuminúria, HVE e pressão arterial. Em nosso meio, alterações qualitativas no perfil de excreção urinária de proteínas são freqüentes em indivíduos hipertensos com e sem tratamento. Microalbuminúria é um marcador de HVE independente da pressão sangüínea. A detecção precoce dessas proteínas permite um melhor acompanhamento do paciente, retardando o aparecimento da disfunção renal conseqüente à HASThe urinary protein excretion profile (UPE) and its relationship with left ventricular hypertrophy (LVH) and 24-hour Ambulatory Monitoring Blood Pressure (AMBP) was evaluated in fifty-three adult hypertensives patients divided in Group I: 30 subjects under therapy and Group II: 24 newly diagnosed individuals without therapy. Urinary creatinine ratios of microalbumin and alpha-1-microglobulin were determined in random urine samples. Serum lipids and creatinine were measured. Qualitative changes in the UPE profiles were observed in 29% of the patients of Group I and in 17% of Group II. Microalbumin was the major excreted protein (23% Group I vs. 13% Group II). Alpha-1-microglobulin was presented in both groups (6% vs. 4%). No difference between levels of microalbumin and alpha-1-microglobulin was observed within groups. Dislipidemia was seen in 70% of the patients but without correlating with microalbuminuria. Group I presented a correlation between LDL-cholesterol and microalbuminuria. LVH was higher in Group I, showing a correlation with microalbuminuria. In Group II significant differences within patients with and without HVE and the mean systolic 24 hour period or ambulatory systolic blood pressure load were seen. Group I showed higher nighttime ambulatory BP and nighttime BP load. No correlation between microalbuminuria and AMBP was observed in both Groups. In conclusion, in our population, qualitative changes in the UPE profile are frequent in both treated and untreated hypertensives subjects. Microalbuminuria is a marker of LVH, independent of BP. The early detection of renal damage by non-invasive methods may permit a careful and non aggressive follow-up of these individuals. The urinary protein excretion profile (UPE) and its relationship with left ventricular hypertrophy (LVH) and 24-hour Ambulatory Monitoring Blood Pressure (AMBP) was evaluated in fifty-three adult hypertensives patients divided in Group I: 30 subjects under therapy and Group II: 24 newly diagnosed individuals without therapy. Urinary creatinine ratios of microalbumin and alpha-1-microglobulin were determined in random urine samples. Serum lipids and creatinine were measured. Qualitative changes in the UPE profiles were observed in 29% of the patients of Group I and in 17% of Group II. Microalbumin was the major excreted protein (23% Group I vs. 13% Group II). Alpha-1-microglobulin was presented in both groups (6% vs. 4%). No difference between levels of microalbumin and alpha-1-microglobulin was observed within groups. Dislipidemia was seen in 70% of the patients but without correlating with microalbuminuria. Group I presented a correlation between LDL-cholesterol and microalbuminuria. LVH was higher in Group I, showing a correlation with microalbuminuria. In Group II significant differences within patients with and without HVE and the mean systolic 24 hour period or ambulatory systolic blood pressure load were seen. Group I showed higher nighttime ambulatory BP and nighttime BP load. No correlation between microalbuminuria and AMBP was observed in both Groups. In conclusion, in our population, qualitative changes in the UPE profile are frequent in both treated and untreated hypertensives subjects. Microalbuminuria is a marker of LVH, independent of BP. The early detection of renal damage by non-invasive methods may permit a careful and non aggressive follow-up of these individual