Abstract 6218: Interrelationships of Asymmetric Dimethylarginine With Low-Grade Inflammation, Adiponectin and Albuminuria in Essential Hypertension
Introduction: Asymmetric dimethylarginine (ADMA), an inhibitor of the nitric oxide synthase, emerges as a marker of cardiovascular risk, while microalbuminuria, hypoadiponectinemia and subclinical inflammation are associated with atherosclerosis progression.
Hypothesis: Urinary albumin excretion, expressed as the albumin to creatinine ratio (ACR), may be related to high-sensitivity C-reactive protein (hs-CRP), adiponectin and ADMA in essential hypertensives.
Methods: Our population consisted of 158 newly diagnosed untreated non-diabetic patients with stage I to II essential hypertension [106 men, mean age=49 years, office blood pressure (BP) =151/97 mmHg]. According to the ACR values determined as the mean of two non-consecutive morning spot urine samples, the study population was divided into microalbuminurics (n=32) (mean ACR=30–300 mg/g) and normoalbuminurics (n=126) (mean ACR<30 mg/g).
Results: Microalbuminurics compared to normoalbuminurics were older (53± 7 vs 49± 6 years, p<0.05), had higher 24-h systolic BP (144± 11 vs 133± 12 mmHg, p<0.001), while did not differ regarding metabolic profile (p=NS). Moreover, microalbuminurics compared to normoalbuminurics exhibited higher levels of ADMA (0.61± 0.04 vs 0.55± 0.03 μmol/l, p=0.001) and hs-CRP (4.5± 1.7 vs 2± 1.1 mg/l, p<0.0001), whereas had lower adiponectin values (5.8± 1.5 vs 9± 2.6 μg/ml, p=0.019), independently of confounders. In the total population, ACR was related to body mass index (r=0.319, p<0.0001), 24-h systolic BP (r=0.263, p<0.0001), ADMA (r=0.366, p<0.0001), hs-CRP (r=0.318, p<0.0001) and adiponectin (r=−0.169, p=0.004). Regarding ADMA, it was associated with 24-h pulse pressure (r=0.404, p<0.0001), hs-CRP (r=0.221, p<0.0001) and adiponectin (r=−0.222, p<0.0001). Multiple regression analysis revealed that 24-h systolic BP, hs-CRP and ADMA were the independent predictors of ACR (R2=0.58, p<0.0001).
Conclusion: Microalbuminuric hypertensives exhibit pronounced inflammatory activation, endothelial dysregulation and hypoadiponectinemia. Moreover, the close association of ADMA with hs-CRP and adiponectin, further establishes endothelial dysfunction as an integrative factor in the interpretation of ACR-related risk.