REV.CHIM.(Bucharest)♦69♦No. 9 ♦2018 http://www.revistadechimie.ro 2425 Prevalence, Characteristics and Predictive Factors of Microalbuminuria in Resistant Systemic Arterial Hypertension CARMEN GADAU 1 , ELENA ARDELEANU 1 *, ROXANA FOLESCU 1 *, IOAN TILEA 2,3 , ANDREEA VARGA 2,3 , ALEXANDRA SIMONA ZAMFIR 4 , , MIHAELA BOANCA 4 , ROMEO PETRU DOBRIN 4 *, LILIANA STRAT 4 , TEIM BAAJ 1 , PATRICIA NICOLA 1 , ALINA COSTINA LUCA 4 , DANIELA GURGUS 1 1 Victor Babes University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq, 300041, Timisoara, Romania 2 University of Medicine and Pharmacy Tirgu Mures, 38 Gheorghe Marinescu Str., 540139, Tirgu Mures, Romania 3 Emergency Hospital Tirgu Mures, Internal Medicine Clinic, 50 Gheorghe Marinescu Str., 540136, Tirgu Mures, Romania 4 Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania The present cross-sectional observational study was made in family medicine offices of Timi’ County, Romania. The aim of the study was to investigate the prevalence of urinary microalbumin excretion (MAU) in resistant systemic arterial hypertension (RH), to analyze patients’ biochemical and clinical characteristics, and the predictive factors for MAU. From a total number of 347 patients, MAU was detected in 76 cases (21.9%). The microalbuminuria positive patients were older, with significant higher office systolic blood pressure (BP) (155 ± 13.50 vs 148 ± 12.40 mmHg, p < 0.0001) and diastolic blood pressure (94 ± 12.20 vs 88 ± 14.6 mmHg, p = 0.0013), higher prevalence of left ventricular hypertrophy, diabetes mellitus, obesity, ischemic and peripheral arterial disease. MAU positive patients presented statistical significant differences in biochemical data concerning: fasting plasma glucose (FPG) (118.80 ± 32.02 vs 108.01 ± 26.01 mg/dL, p = 0.003), impaired glucose tolerance (IGT) (10.52 % vs 4.94 %), glycated hemoglobin (HbA1c) (6.56 ± 0.98% vs 5.96 ± 0.91%, p < 0.001), reduced estimated glomerular filtration rate (eGFR) (56.10 ± 15.4 vs 69.30 ± 17.5 ml/min/1.73m 2 , p < 0.001) and higher potassium levels (4.71 ± 0.43 vs 4.59 ± 0.44 mg/dL, p = 0.0378). No significant differences were noticed regarding LDL- and HDL-cholesterol, triglycerides, uric acid and serum creatinine. In a logistic multivariate analysis independent predictors for MAU were: systolic BP (odds ratio, OR = 1.024, 95% confidence interval, CI:1.011-1.039, p < 0.001), HbA1c (OR = 1.324, 95% CI: 1.078-1.724, p = 0.008) and eGFR (OR = 0.989, 95% CI: 0.977-0.999, p = 0.01). Our findings suggest that an important part of RH patients have microalbuminuria and highlight the importance of controlling its predictors, in order to improve patients’ outcome. Keywords: microalbuminuria, resistant systemic arterial hypertension-evaluation The European Hypertension/Cardiology Society Guidelines [1] highlight the necessity to investigate target organ damage secondary to systemic arterial hypertension (HT) as left ventricular hypertrophy (LVH), reduced glomerular filtration rate (GFR), microalbuminuria (MAU) and macro-albuminuria, factors that are related to a greater cardiovascular (CV) morbidity and mortality. Epidemiological studies [2, 3] have demonstrated that chronic kidney disease (CKD) is an independent risk factor for HT and that even very low levels of microalbuminuria strongly correlate toCV risk, independent of the presence of other risk factors [4]. It was demonstrated that MAU is a marker of endothelial dysfunction that predicts a greater incidence of target organ damage, cardio- and cerebrovascular events and that its reduction lowers these comorbidities [5]. The reported prevalence of MAU is highly variable among studied populations, ranging from 7% to 58.4% [6, 7]. This variation can be explained by differences in population characteristics, investigation methods and prescribed drugs [8 - 10]. Early identification of high-risk patients through detection of MAU allows selection of treatment regimens based on angiotensin II blockade in order to assure its regression and prevent progression [11]. The aim of the study was to evaluate the prevalence of MAU in RH patients in primary care setting and to establish the biochemical and clinical profile of these patients and the predictors for MAU. Experimental part Material and methods This is an observational cross-sectional study, done between 2011 and 2017, involving 19 general practitioners (GPs) from Timis County, Romania and affiliated university hospitals. From a number of 5146 hypertensive patients who were evaluated during the medical visits at the GPs offices and treated for at least three months, a number of 347 adult patients fulfilled the criteria of RH (treated with three or more antihypertensive agents, in optimal doses or maximal tolerated , including a diuretic, not reaching target blood pressure (BP) < 140/90 mmHg). RH included also controlled hypertension patients, treated with four or more antihypertensive drugs [1]. Exclusion criteria were secondary HT, acute myocardial infarction, instable angina and stage 5 of CKD. At the beginning of the study all participants signed a written informed consent. The study was approved by the Ethics Committee of the University of Medicine and Pharmacy Victor Babes Timisoara and acoordind to some published models and guidelines [12, 13]. Demographic informations were obtained from written questionnaires. The GPs performed history, physical examination and measured height, weight, blood pressure (BP), the body mass index (BMI) being calculated. The laboratory analyses included total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), triglycerides (TG), uric acid, creatinine, eGFR, urine analysis, fasting plasma glucose * email: aelena.ardeleanu@gmail.com, roxanafolescu08@gmail.com; romeodobrin2002@gmail.com