CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
AFRICA
201
participating physicians completed a site questionnaire that
documented practice location (urban, suburban or rural) and type
(community or hospital based) as well as duration of service,
degree of awareness and experience in detection of MAU, and its
clinical relevance. In the second step, at each site, consecutive
patients fulfilling eligibility criteria were invited to participate in
the study. The study was conducted in accordance with the ethi-
cal principles of the current Declaration of Helsinki and consist-
ent with the international conference on harmonisation and good
clinical practice.
Inclusion criteria were as follows: male and female outpa-
tients aged 18 years or older, with currently treated or newly
diagnosed arterial hypertension, defined as a seated systolic
(SBP)/diastolic blood pressure (DBP) of
≥
140/90 mmHg at rest
on the day of the study visit. Patients with acute fever (
>
38°C),
renal disease (serum creatinine
>
20 mg/l), concomitant urinary
tract infection, treated with cimetidine, or having undertaken
strenuous physical activity in the preceding 24 hours, as well as
female subjects who were pregnant or menstruating were ineli-
gible to participate due to the likelihood of false positive results.
Once enrolled, demographic data, cardiovascular history, risk
factors and co-morbidities, symptoms and signs of cardiovascu-
lar disease and current chronic drug therapy were documented
on the case report form. The following measurements were
then carried out on each patient: heart rate, urinary albumin and
creatinine concentration, and waist and hip circumference. To
ensure consistency between study sites, all centres performed
dipstick screening for MAU with sponsor-provided reagent
strips (Microalbustix
®
), which have a sensitivity of 82.6%,
15
and
followed a standardised sample-collection and testing procedure.
Urine albumine levels were grouped into categories: 10, 30, 80
or 150 mg/l.
The primary objective of this study was to define the preva-
lence of MAU in hypertensive outpatients attending a cardiolo-
gist. Secondary objectives were to establish a correlation between
the prevalence of MAU and known cardiovascular risk factors in
the study population, and to increase physicians’ awareness of
the importance of MAU screening to identify at-risk patients.
Statistical analyses
Population characteristics were recorded as numbers, means
and standard deviations, together with 95% confidence inter-
vals (CI) for the means of quantitative variables, and numbers
and percentages with 95% CI of the population for categori-
cal data. Outcomes included prevalence of MAU with 95%
CI, taking into account the cluster design effect using the Proc
SURVEYMEANS in SAS for categorical variables. The associa-
tion between high levels of MAU and cardiovascular risk factors
was studied and odds ratios were calculated. For the calculations
SAS version 8.2 was used.
16
Results
Over the six months’ recruitment period, 476 patients were
screened at 40 cardiology practices in Morocco (22 282 world-
wide). One patient did not sign the informed consent and 18
patients did not meet the pre-specified inclusion and exclusion
criteria or had no documented albumin or creatinine values. The
primary analysis was done on 457 patients.
Patients were on average 59.1
±
11.1 years old, and 59.7%
were female. The majority (81.4%) had uncontrolled hyperten-
sion (SBP
≥
140 mmHg and/or DBP
≥
90 mmHg) of duration 4.5
±
4.5 years, and the mean blood pressure was 161.4
±
27.7/91.1
±
14.1 mmHg on the day of the study. Cardiovascular risk profiles
of the Moroccan patients compared to the worldwide study
TABLE 1. CARDIOVASCULAR RISK PROFILE
(PRIMARYANALYSIS POPULATION)
Parameter (mean
±
SD or %)
Morocco
(
n
=
457)
Global survey
(
n
=
21 050)
Demographics
Age (years)
59.1
±
11.1 62.4
±
11.7
Male gender (%)
40.3
52.3
BMI (kg/m
2
)
28.6
±
5.8 28.9
±
5.7
Hypertension
Duration (years)
4.6
±
4.5 8.1
±
7.7
SBP (mmHg)
161.4
±
27. 149.2
±
20.2
DBP (mmHg)
91.1
±
14.1 87.4
±
11.8
Proportion uncontrolled (140/90 mmHg) (%)
81.4
76.8
Heart rate/sinus rhythm
Heart rate (bpm)
74.7
±
12.3 74
±
12
Sinus rhythm: yes (%)
96.4
94.8
Cardiovascular risk factors
Family history MI/CAD (%)
14. 4
27.8
Regular physical activity (%)
17.7
35.0
Current/former smoker (%)
6.8/5.3
14.2/20.5
Current diabetics (%)
19.1
27.5
Diabetes type 1/type 2 (%)
11.5/88.5 4.9/95.1
Duration of diabetes (years)
6.8
±
5.5 7.9
±
7.7
Additional risk factors
Total cholesterol (mmol/l)
5.5
±
1.2 5.3
±
1.1
HDL-C (mmol/l)
1.3
±
0.5 1.3
±
0.5
LDL-C (mmol/l)
3.0
±
1.4 3.2
±
1.0
Triglycerides (mmol/l)
1.6
±
1.0 1.8
±
1.0
CRP (mg/dl)
1.1
±
0.9 0.9
±
0.9
Serum creatinine (
m
mol/l)
91.9
±
26.9 89.9
±
23.8
Creatinine clearance (ml/min)
90.0
±
35.5 87.9
±
34.1
<
30 ml/min (%)
0
0.7
30–60 ml/min (%)
21.3
19.3
60–80 ml/min (%)
23.7
26.5
80–120 ml/min (%)
36
38.8
>
120 ml/min (%)
19
14.8
Co-morbidities
Coronary artery disease (%)
10.1
22.9
Congestive heart failure (%)
4.4
5.8
Atrial fibrillation (%)
4.2
8.3
History of ischaemic stroke
8.6
4.8
History of TIA (%)
4.4
3.8
Peripheral artery disease (%)
3.1
4.2
Other cardiovascular disease
LVH (indice de Sokolow en mm)
31.7
±
9.4
(
n
=
246)
24.8
±
9.8
(
n
=
8 311)
Ejection fraction
≤
40% (%)
4.9
4.7
Carotid stenosis (%)
1.3
2.9
Aortic aneurysm (%)
0.4
1.4
SD: standard deviation, LVH: left ventricular hypertrophy, TIA: transient
ischaemic attack, CRP: C-reactive protein, MI: myocardial infarction.
