Association of Hypertension and Obesity with Echocardiographic Left Ventricular Hypertrophy or Microalbuminuria in a General Population in South Korea

Yu-Mi Kim; Sang Woong Han; Bae Ken Kim; Mi Kyung Kim; Bo Youl Choi; Jin Ho Shin

doi:10.5646/jksh.2011.17.4.156

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Kim, Han, Kim, Kim, Choi, and Shin: Association of Hypertension and Obesity with Echocardiographic Left Ventricular Hypertrophy or Microalbuminuria in a General Population in South Korea

Original Article

J Korean Soc Hypertens 2011;17(4):156-165.

Published online: 10 December 2011

DOI: https://doi.org/10.5646/jksh.2011.17.4.156

Association of Hypertension and Obesity with Echocardiographic Left Ventricular Hypertrophy or Microalbuminuria in a General Population in South Korea

Yu-Mi Kim, MD¹, Sang Woong Han, MD², Bae Ken Kim, MD², Mi Kyung Kim, MD³, Bo Youl Choi, MD³, Jin Ho Shin, MD^2,

¹Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea

²Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

³Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea

Tel: 02) 2290-8308, Fax: 02) 2299-0278 E-mail: jhs2003@hanyang.ac.kr

Received 6 September 201130 November 2011 Accepted 9 December 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background:

Both left ventricular hypertrophy (LVH) and microalbuminuria (MA) are well described markers or surrogate for cardiovascular outcome. Many factors are known to be related to the two markers which are encountered together in some patients. But the epidemiological backgrounds for the two markers are not clearly demonstrated so far.

Methods:

Measurements of echocardiographic left ventricular mass index (LVMI) and MA were introduced to the population survey in Yangpyeong County, Korea in 2005 and 2006 for 1,767 among 2,028 subjects. The criteria for MA were 17-250 mg/g of albumin creatinine ratio (ACR) in male and 25-355 mg/g in female. 1,636 data were analyzed.

Results:

Age was 60.9 ± 10.4 years and the proportion of female was 59.4% (972). Body mass index (BMI) was 24.7 ± 3.21 kg/m² and blood pressure were 124.1 ± 17.3 mm Hg/80.0 ± 10.5 mm Hg. LVMI was 45.3 ± 11.6 g/m^2.7 and ACR was 23.9 ± 150.9 mg/g. Prevalence of LVH and MA were 23.5% and 12.2%, respectively. In male/female, odds ratios for MA were 1.035 (range, 1.010-1.061)/1.01 (range, 0.988-1.032) for age, 0.962 (range, 0.882-1.049)/0.941 (range, 0.881-1.006) for BMI, 1.754 (range, 1.097-2.804)/ 2.158 (range, 1.413-3.298) for hypertension (HTN), 4.87 (range, 2.883-8.226)/2.154 (range, 1.311-3.539) for diabetes, 1.005 (range, 0.999-1.012)/1.007 (range, 1.002-1.012) for cholesterol, and 1.011 (range, 0.987-1.035)/1.011 (range, 0.994-1.029) for LVH.

Conclusions:

In a population level, even if diabetes was strongest factor for MA, HTN is also independent factor for MA in both genders.

Keywords: Hypertrophy, Left ventricular, Albuminuria, Hypertension, Obesity

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Table 1.

Characteristics of the study population

	Total (n=1,635)	Male (n=665)	Female (n=971)	p-value
General characteristics and anthropometrics
Age (yr)	60.94 ± 10.40	61.53 ± 10.27	60.53 ± 10.48	0.0574
Body mass index (kg/m²)	24.71 ± 3.21	24.23 ± 3.06	25.04 ± 3.27	＜0.0001
Waist circumference (cm)	87.77 ± 8.27	88.21 ± 7.91	87.46 ± 8.50	0.0677
Systolic blood pressure (mmHg)	124.13 ± 17.39	125.69 ± 17.03	123.06 ± 17.56	0.0026
Diastolic blood pressure (mmHg)	80.01 ± 10.52	81.6 ± 10.91	78.93 ± 10.10	＜0.0001
Clinical examination
Cholesterol (mg/dL)	197.67 ± 37.24	189.23 ± 34.86	203.45 ± 37.73	＜0.0001
Triglyceride (mg/dL)	155.99 ± 97.21	168.22 ± 108.94	147.62 ± 87.37	＜0.0001
HDL (mg/dL)	46.06 ± 10.88	44.83 ± 11.32	46.91 ± 10.49	0.0002
Creatinine (mg/dL)	0.94 ± 0.17	1.05 ± 0.15	0.87 ± 0.13	＜0.0001
Fasting blood glucose (mg/dL)	102.8 ± 24.01	104.62 ± 23.99	101.55 ± 23.96	0.0109
Echocardiographic indices
Heart rate (beats per minute)	65.21 ± 9.67	64.95 ± 10.13	65.39 ± 9.34	0.3652
IVSd (cm)	0.93 ± 0.13	0.97 ± 0.12	0.91 ± 0.13	＜0.0001
LVDd (cm)	4.89 ± 0.46	5.03 ± 0.45	4.79 ± 0.44	＜0.0001
PWTd (cm)	0.87 ± 0.11	0.9 ± 0.10	0.84 ± 0.11	＜0.0001
LV mass (g)	154.74 ± 39.61	170.49 ± 39.25	143.95 ± 36.11	＜0.0001
LV mass index (g/m^2.7)	45.32 ± 11.64	43.92 ± 10.19	46.27 ± 12.44	＜0.0001
Spot urine examination
Urine albumin (mg/dL)	1.73 ± 7.97	2.06 ± 10.34	1.5 ± 5.81	0.2063
Urine creatine (mg/dL)	103.8 ± 60.39	123.33 ± 64.61	90.43 ± 53.38	＜0.0001
Albumin creatinine ratio (mg/g)	23.92 ± 150.86	23.22 ± 152.15	24.4 ± 150.05	0.8765

Values are presented as mean±standard deviation.

p-value for sex comparison by independent t-test.

HDL, high density lipoprotein; IVSd, end-diastolic interventricular septal thickness; LV, left ventricular; LVDd, end-diastolic left ventricular dimension; PWTd, end-diastolic posterior wall thickness.

Table 2.

Distribution of metabolic abnormality, echocardiographic LVH and albuminuria in the study population

	Total	Male	Female	p-value
HTN medication	438 (26.8)	137 (20.6)	301 (31.0)	＜0.0001
HTN	684 (41.8)	265 (39.9)	419 (43.2)	0.1836
DM medication	132 (8.1)	50 (7.5)	82 (8.4)	0.4993
DM	207 (12.7)	90 (13.5)	117 (12.1)	0.375
LVH	384 (23.5)	126 (19.0)	258 (26.6)	0.0004
Microalbumiuria	200 (12.2)	86 (12.9)	114 (11.7)	0.5405
Macroalbumiuria	18 (1.1)	9 (1.4)	9 (0.9)	-
LVH with albuminuria	58 (3.5)	20 (3.0)	38 (3.9)	0.3304

Values are presented as number (%).

p-value by chi-square test. HTN defined by systolic blood pressure ≥140mmHg, diastolic blood pressure ≥90mmHg, or taking antihypertensive medication. DM defined by fasting serum glucose ≥126mg/dL or taking antihypertensive medication.

LVH, left ventricular hypertrophy; HTN, hypertension; DM, diabetes.

Table 3.

Correlation coefficients of age, obesity and blood pressure with left ventricular mass index and albumin creatinine ratio

	Male				Female
	LVMI		ACR		LVMI		ACR
	r	p	r	p	r	p	r	p
Age (yr)	0.05077	0.191	0.04946	0.2028	0.35465	＜0.0001	0.08462	0.0083
Body mass index (kg/m²)	0.35994	＜0.0001	-0.02081	0.5921	0.37471	＜0.0001	-0.03064	0.3402
Waist circumference (cm)	0.2797	＜0.0001	0.00738	0.8495	0.33609	＜0.0001	-0.00276	0.9315
Systolic blood pressure (mm Hg)	0.19302	＜0.0001	0.11342	0.0034	0.28867	＜0.0001	0.09955	0.0019
Diastolic blood pressure (mm Hg)	0.10664	0.0059	0.02656	0.4942	0.13731	＜0.0001	0.05074	0.1141
LVMI			0.03465	0.3724			0.01076	0.7378

r means Pearson’s correlation coefficient.

LVMI, left ventricular mass index; ACR, albumin creatinine ratio (mg/g).

Table 4.

Sex stratified mean comparison of covariates across the microalbumiuria

	Male			Female
	Normal	Microalbumiuria	p-value	Normal	Microalbumiuria	p-value
Age (yr)	61.02 ±10.20	64.56 ±10.25	0.0018	60.11 ± 10.53	63.42 ± 9.72	0.001
Body mass index (kg/m2)	24.22 ±3.01	24.25 ±3.34	0.9386	25.04 ± 3.27	25.02 ± 3.28	0.9377
Waist circumference (cm)	88.07 ±7.80	89.07 ±8.59	0.2503	87.36 ± 8.44	88.15 ± 8.91	0.3338
Systolic blood pressure (mm Hg)	124.84 ±15.33	130.81 ±24.40	0.0228	121.83 ± 16.85	131.56 ± 19.93 ＜	＜0.0001
Diastolic blood pressure (mm Hg)	81.36 ±10.01	83.02 ±15.25	0.3086	78.39 ± 9.62	82.64 ± 12.39	0.0004
Cholesterol (mg/dL)	188.3 ±35.17	194.81 ±32.54	0.092	201.99 ± 37.56	213.5 ± 37.53	0.0015
Triglyceride (mg/dL)	164.18 ±106.51	192.46 ±120.26	0.019	143.45 ± 81.31	176.34 ± 117.62	0.0032
HDL (mg/dL)	44.84 ±11.28	44.78 ±11.63	0.9632	46.85 ± 10.52	47.29 ± 10.37	0.6657
Fasting blood glucose (mg/dL)	102.09 ±19.78	119.83 ±37.72	＜0.0001	100.18 ± 20.85	110.98 ± 38.01 ＜	＜0.0001
LV mass index (g/m2.7)	43.71 ±10.28	45.16 ±9.61	0.2003	45.89 ± 12.46	48.91 ± 12.07	0.0119

p-value by independent t-test.

HDL, high density lipoprotein; LV, left ventricular.

Table 5.

Multiple logistic regression analysis regarding the covariates related to microalbumiuria

		Crude model	Age adjusted model	Multiple model
Male	Age (yr)		1.035 (1.012-1.059)	1.035 (1.010-1.061)
	BMI			0.962 (0.882-1.049)
	HTN			1.754 (1.097-2.804)
	DM			4.87 (2.883-8.226)
	Cholesterol			1.005 (0.999-1.012)
	LVH	1.014 (0.993-1.035)	1.012 (0.991-1.033)	1.011 (0.987-1.035)
Female	Age (yr)		1.027 (1.007-1.048)	1.01 (0.988-1.032)
	BMI			0.941 (0.881-1.006)
	HTN			2.158 (1.413-3.298)
	DM			2.154 (1.311-3.539)
	Cholesterol			1.007 (1.002-1.012)
	LVH	1.018 (1.004-1.033)	1.011 (0.996-1.027)	1.011 (0.994-1.029)

Values are presented as OR (95% CI).

HTN defined by systolic blood pressure ≥140mmHg, diastolic blood pressure ≥90mmHg, or taking antihypertensive medication. DM defined by fasting serum glucose ≥126mg/dL or taking antihypertensive medication.

OR, odds ratio; CI, confidence interval; BMI, body mass index; HTN, hypertension; DM, diabetes; LVH, left ventricular hypertrophy.

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