Sub-clinical organ damage in hypertension and obesity

Background: The development of sub-clinical organ damage precedes and predicts the occurrence of cardiovascular (CV) events in hypertensive as well as in obese patients. Aim and methods: We investigated the prevalence and clinical correlates of organ damage (OD), namely carotid atherosclerosis (US scan) and urine albumin to creatinine ratio (three non-consecutive first morning samples) in a group of 164 obese patients and in an age- and gender-matched group of non-obese hypertensive patients. Results: There was a significantly greater prevalence and severity of OD in obese patients as compared to non-obese hypertensive patients. In particular obese patients more frequently had microalbuminuria (16 vs7%, chi(2) 5.8, P = 0.0157) and carotid abnormalities (53 vs 10%, chi(2) 69.5, P < 0.0001) as well as higher urinary albumin excretion rate (-0.05 +/- 0.52 vs -0.28 +/- 0.43log ACR, P < 0.0001) and carotid intima-media thickness (0.955 +/- 0.224 vs 0.681 +/- 0.171, < 0.0001). Notably, the coexistence of hypertension and obesity did not entail a greater prevalence and severity of OD. Moreover, after adjusting for potentially confounding factors including blood pressure levels, diagnosis of diabetes, and lipid profile, morbidly obese patients showed a 5-fold, and 22-fold higher risk of having microalbuminuria, and carotid atherosclerosis, respectively. Conclusions: Sub-clinical OD is highly prevalent in obese patients, even in the absence of high blood pressure. Hypertension and obesity seem to exert an independent, possibly non-additive role on the occurrence of organ damage. (c) 2009 Elsevier B.V. All rights reserved.