CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
AFRICA
203
The present sub-analysis of the Moroccan centres of the
global i-SEARCH survey generated the following key results:
(1) patients in Morocco were grossly comparable to the patient
population of the global survey, except for a lower rate of diabe-
tes and a higher rate of uncontrolled blood pressure; (2) the
prevalence of MAU in hypertensive patients in clinical cardiol-
ogy (67.83%) exceeded that found in the general population and
in primary care, while physicians consider MAU as a cardiovas-
cular risk marker; (3) MAU was associated with a number of
cardiovascular risk factors and disease; (4) beta-blockers were
more frequently prescribed in MAU-positive patients compared
to ARBs or ACE inhibitors.
The prevalence of MAU found in this sample of hypertensive
patients in a cardiological outpatient setting indicates that this
cardiovascular risk factor is very common in clinical cardiology
(67.83%). It was furthermore, substantially higher than found
in studies on unselected persons in the general population,
17,18
and patients in primary care.
19,20
The HYDRA study in primary
care, for example,
19,21
has documented a prevalence of 21.2%
of patients with hypertension and 37.8% of patients with both
hypertension and diabetes. The global DEMAND study has
documented a prevalence of MAU and hypertension of 39% in
general practice.
20
Explanations for the higher prevalence of MAU in i-SEARCH
may be as follows: the study population was older than in most
previous studies, and 27.5% of the enrolled hypertensive patients
were diabetic, whereas in other studies,
22-23
diabetic subjects
were excluded. Patients with known albuminuria were also not
excluded as was the case in the DEMAND study.
20
This and the
high-risk cardiovascular population attending a cardiologist in
comparison to those seeking primary care may account for the
observed differences and the higher prevalence reported in the
present study.
Comparing the Moroccan results to the global ones, it is
apparent that the prevalence of MAU is higher in Morocco
(67.83 vs 58.4%). Despite this, the estimated true prevalence
by physicians in their patient cohort, its assessment and the use
of this marker for therapeutic decisions is low. This finding has
also been documented for general practitioners (HYDRA).
19
It reflects a discrepancy between physician awareness of the
prognostic importance of MAU and actual screening for MAU
in cardiology practice.
MAU was associated with a number of cardiovascular risk
factors and disease in the present study. This observation is in
line with previous data stemming from population-based stud-
ies
17
and primary care.
19,21
It indicates that MAU is common in
patients referring to cardiology departments and is associated
with a number of other cardiovascular risk factors. This associa-
tion was previously described in clinical studies for males
24
and
older patients,
25
those with diabetes,
26
obesity,
27
smoking,
28
insulin
resistance syndrome,
29
left ventricular hypertrophy (LVH),
30
left
ventricular dysfunction
31
and C-reactive protein
32
(not significant
in the present study).
Fig. 3. Number of cardiovascular risk factors associated with the presence of MAU. The risk factors concerned are:
no regular physical activity, current smoking, known hyperlipidaemia, family history of myocardial infarction or docu-
mented coronary artery disease or diabetes.
100
80
60
40
20
0
0
1
2
3
4
5
Total
Morocco
Global
% of patients
Number of risk factors
67.5%
50.5%
67.7% 64.3%
83.3%
70.2%
100.0%
69.7%
67.8%
58.4%
59.5%
66.7%
55.7%
67.9%
Fig. 5. Use of pharmacotherapy overall and presence of
MAU in specific classes.
50
40
30
20
10
0
Beta-
blockers Thiazides CCB ACE
inhibitors ARBs
% of patients
Drug classes
42.7%
34.6%
26.5%
30.6%
23.4%
Fig. 4. Number of cardiovascular diseases associated
with the presence of MAU: history of myocardial infarc-
tion or CABG, history of ischaemic stroke or carotid
endarterectomy or carotid angioplasty, peripheral arterial
disease.
100
80
60
40
20
0
0
1
2
3
Total
Morocco
Global
% of patients
Number of CV disease
66.5%
56.7%
74.0%
63.1%
91.7%
71.0%
50.0%
65.9% 67.8%
58.4%
