Hypertension is a major global health concern, affecting over a billion individuals and serving as a leading risk factor for cardiovascular morbidity and mortality [1]. Despite significant advances in the management of hypertension, many patients continue to experience adverse cardiovascular events, underscoring the need for early and reliable markers to identify those at highest risk [2]. Microalbuminuria, defined as a modest elevation in urinary albumin excretion below the threshold for overt proteinuria, has emerged as a sensitive and early indicator of vascular dysfunction and end-organ damage in hypertensive patients [1,3].

Microalbuminuria reflects subtle but widespread endothelial dysfunction, which is a precursor to atherosclerosis and cardiovascular disease [3,4]. Numerous studies have demonstrated that even low-grade increases in urinary albumin excretion are independently associated with an increased risk of cardiovascular events, including ischemic heart disease, heart failure, and stroke, regardless of other traditional risk factors [4,5]. For instance, prospective cohort studies have shown that hypertensive individuals with microalbuminuria have a fourfold greater risk of developing ischemic heart disease compared to those with normoalbuminuria, independent of blood pressure levels and other atherosclerotic risk factors [4]. Furthermore, microalbuminuria is closely linked to left ventricular hypertrophy, arterial stiffness, and increased carotid intima-media thickness, all markers of subclinical cardiovascular damage [1].

The pathophysiology underlying microalbuminuria in hypertension is multifactorial. Elevated intraglomerular pressure and generalized angiopathy due to endothelial dysfunction increase renal and systemic vascular permeability, resulting in albumin leakage into the urine [2]. This process not only signifies renal involvement but also mirrors systemic vascular injury, making microalbuminuria a valuable marker of global cardiovascular risk [1,3]. The prevalence of microalbuminuria among hypertensive patients varies, with studies reporting rates ranging from 17% to over 60%, influenced by factors such as age, blood pressure control, and coexisting diabetes [2,6].

Routine screening for microalbuminuria in hypertensive patients is increasingly advocated by international guidelines, given its prognostic significance and the opportunity it provides for early intervention [3]. Early detection of microalbuminuria allows for intensified risk factor modification, including stricter blood pressure control, use of renin-angiotensin system inhibitors, and management of dyslipidemia and glycemic status, all of which have been shown to reduce albuminuria and improve cardiovascular outcomes [3,6]. Despite its clinical importance, microalbuminuria remains underrecognized and underutilized in routine practice, with measurement performed in a minority of eligible patients [6].

Recent evidence also highlights the reversibility of microalbuminuria with effective therapeutic strategies, further emphasizing its role not only as a risk marker but also as a modifiable target for intervention [3]. The practical utility of microalbuminuria is enhanced by the availability of simple, non-invasive, and cost-effective methods for its detection, such as the urinary albumin-to-creatinine ratio in spot urine samples [2,3]. Given these attributes, microalbuminuria represents a critical tool for the early identification of hypertensive patients at elevated cardiovascular risk and for guiding the intensity of preventive strategies.

In summary, the assessment of microalbuminuria offers a unique opportunity to detect early cardiovascular risk and target organ damage in hypertensive patients. Its integration into routine clinical evaluation can facilitate timely and tailored management, ultimately reducing the burden of cardiovascular disease in this high-risk population. This study aims to further elucidate the relationship between microalbuminuria and cardiovascular risk in hypertensive patients, reinforcing its value as an early and actionable biomarker.

This hospital-based, observational, cross-sectional study was conducted over a period of one year at a tertiary care center in Central India. A total of 110 adult patients (aged ≥18 years) diagnosed with essential hypertension and attending the outpatient or inpatient departments were included in the study after obtaining informed consent. Patients of both sexes were enrolled. Exclusion criteria included individuals with known diabetes mellitus, chronic kidney disease, urinary tract infections, recent febrile illness, overt proteinuria, or those on nephrotoxic drugs or lipid-lowering therapy, to avoid confounding factors that could influence urinary albumin levels.

Detailed demographic data, clinical history, and information regarding lifestyle habits (such as smoking and alcohol consumption) were recorded using a structured proforma. Clinical examination included measurement of height, weight, and blood pressure using a standard sphygmomanometer. Body mass index (BMI) was calculated, and blood pressure control status was classified based on standard guidelines. Blood samples were collected to assess lipid profile and serum creatinine levels. Urine samples were collected as spot early morning specimens to measure the urine albumin-to-creatinine ratio (UACR), and patients were categorized into normoalbuminuria and microalbuminuria groups based on UACR values.

Microalbuminuria was defined as a UACR ranging between 30–300 mg/g. All laboratory tests were conducted using standardized methods in the hospital’s central laboratory. Patients were evaluated for the presence of other cardiovascular risk factors such as elevated LDL levels, sedentary lifestyle, family history of cardiovascular disease, smoking, alcohol use, and poor blood pressure control. Data were compiled and analyzed using SPSS software. Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. The association between microalbuminuria and various cardiovascular risk factors was assessed using chi-square tests and independent t-tests. A p-value of less than 0.05 was considered statistically significant.

Table 1: Demographic and Baseline Characteristics of Patients (n = 110)

This table presents the demographic profile of the 110 hypertensive patients, categorized by sex. The average age of participants was approximately 55 years, with a slightly higher mean age in males. A majority of patients were between 50–65 years old. More than half had a duration of hypertension exceeding five years and a high prevalence of elevated BMI, indicating increased cardiovascular risk across the group.

Table 2: Clinical Presentation and Risk Factors

This table outlines major cardiovascular risk factors observed in the hypertensive cohort. Sedentary lifestyle, elevated LDL levels, and poor blood pressure control were notably common. Additionally, over one-third of patients reported smoking, and nearly half had a positive family history of cardiovascular disease, reinforcing the need for early risk stratification strategies like microalbuminuria assessment.

Table 3: Prevalence of Microalbuminuria Among Study Population

This table classifies patients based on urinary albumin excretion, showing that 38.2% of hypertensive individuals had microalbuminuria. This significant proportion underscores its potential as a useful early indicator of endothelial dysfunction and cardiovascular risk in hypertensive patients even before overt symptoms of heart disease develop.

Table 4: Association Between Microalbuminuria and Cardiovascular Risk Factors

This table demonstrates the higher prevalence of key cardiovascular risk factors among patients with microalbuminuria compared to those without. It shows strong associations between microalbuminuria and advanced age, uncontrolled hypertension, elevated LDL, and smoking. These results highlight microalbuminuria's role as a marker of cumulative cardiovascular burden.

Table 5: Mean Values of Biochemical and Hemodynamic Parameters

This table compares key biochemical and hemodynamic parameters between patients with and without microalbuminuria. Systolic and diastolic blood pressure, LDL cholesterol, serum creatinine, and urine albumin-to-creatinine ratio (UACR) were all significantly higher in the microalbuminuria group, affirming the clinical utility of UACR as an early marker of end-organ damage and cardiovascular risk in hypertensive individuals.

The present study evaluated the prevalence of microalbuminuria and its association with cardiovascular risk factors among hypertensive patients. A total of 110 patients were enrolled, comprising 65 males and 45 females, with a mean age of approximately 55 years. A significant proportion of participants were middle-aged or elderly and had a long-standing history of hypertension. Notably, a large percentage had elevated BMI and poorly controlled blood pressure—both of which are established contributors to cardiovascular morbidity. These demographic and clinical characteristics are consistent with previous reports by El Midaoui et al., who found that microalbuminuria is particularly prevalent among older, overweight, and poorly controlled hypertensive patients [7]. Similarly, Dounousi et al. reported that microalbuminuria was more common in hypertensive individuals with longer disease duration and higher BMI [8]. Microalbuminuria was observed in 38.2% of the study population, underscoring its considerable presence in patients with hypertension. This finding is clinically important as microalbuminuria is widely recognized as an early marker of endothelial dysfunction and subclinical organ damage, especially in the renal and cardiovascular systems. The prevalence rate in this study aligns with previous findings by Pontremoli et al., who reported microalbuminuria in 30–40% of hypertensive cohorts [9]. Likewise, Ruggenenti and Remuzzi documented similar rates and emphasized the prognostic significance of microalbuminuria in predicting cardiovascular events in hypertensive patients [10]. The study further demonstrated a strong correlation between microalbuminuria and conventional cardiovascular risk factors. Patients with microalbuminuria were more likely to be older, have poorly controlled blood pressure, elevated LDL cholesterol levels, a sedentary lifestyle, and a history of smoking. These associations reinforce the idea that microalbuminuria is not an isolated renal phenomenon but rather a marker of systemic vascular injury resulting from the cumulative burden of risk factors. Jensen et al. also observed that microalbuminuria was independently associated with age, blood pressure, lipid abnormalities, and smoking, supporting its role as a comprehensive risk marker [11]. Similarly, the PREVEND study found that microalbuminuria clustered with multiple cardiovascular risk factors and predicted future cardiovascular events [12]. In terms of biochemical and hemodynamic parameters, patients with microalbuminuria exhibited significantly higher systolic and diastolic blood pressure, LDL cholesterol, serum creatinine, and urine albumin-to-creatinine ratio [UACR]. These findings further support the role of microalbuminuria as a surrogate marker for early cardiovascular stress and target organ damage. The elevated creatinine levels in this group may also point to early renal involvement, adding another dimension to cardiovascular risk prediction. These results are in agreement with the findings of Verhave et al., who demonstrated that microalbuminuria is associated with higher blood pressure, dyslipidemia, and impaired renal function in hypertensive populations [13]. Similarly, Gerstein et al. found that microalbuminuria predicted both renal and cardiovascular outcomes, even after adjusting for other risk factors [14].From a clinical perspective, the findings advocate for the routine assessment of microalbuminuria in hypertensive patients, especially those with additional risk factors such as obesity, smoking, and poor blood pressure control. UACR testing is a simple, non-invasive, and cost-effective tool that can facilitate early identification of high-risk individuals and prompt timely interventions. Its integration into standard hypertensive care protocols may improve long-term cardiovascular outcomes by enabling more aggressive risk factor modification. This recommendation echoes the conclusions of the European Society of Cardiology guidelines, which endorse microalbuminuria screening for risk stratification in hypertension management [15]. However, this study has several limitations. As a single-center, cross-sectional study, it provides a snapshot in time without establishing causality or longitudinal outcomes. Additionally, the absence of cardiovascular imaging or echocardiographic assessment limits the scope of cardiovascular risk stratification. Larger, multicenter, prospective studies are needed to validate these findings, evaluate the predictive value of microalbuminuria for actual cardiovascular events, and assess the potential benefits of targeted interventions to reduce albuminuria. Similar limitations have been noted in previous studies, such as those by Ruggenenti and Remuzzi, and by Verhave et al., who also called for larger and longer-term studies to clarify the prognostic value and therapeutic implications of microalbuminuria in hypertension [10,13].

In our study microalbuminuria is a prevalent and clinically relevant marker in hypertensive patients, reflecting heightened cardiovascular risk even in the absence of overt disease. Its association with key modifiable risk factors makes it a valuable tool for early detection and risk stratification. Incorporating microalbuminuria screening into routine clinical practice may enhance the management of hypertension and help mitigate future cardiovascular complications.

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