Recent studies on catecholamine physiology have shown a direct correlation with arterial hypertension, overcoming the exclusive role in the diagnosis and follow-up of chromaffin tumors. Nevertheless, in literature, few studies explore and reveal the utility of testing metanephrines for the evaluation of sympathetic activity and its associated cardiometabolic complications in patients with essential hypertension.
Catecholamines (noradrenaline, adrenaline and dopamine) are adaptive and maladaptive stress hormones. In the classic "fight or flight" mechanism, they activate behavioral and physiological processes that facilitate the overcoming of stress; for instance, challenged by a physical stressor, an organism responds to the threat either fighting and prevailing or accepting defeat and fleeing in avoidance. In the pathological context, an excessive catecholamine secretion is typical of the chromaffin tissue tumors, determining a clinical picture characterized by blood pressure elevation, tachycardia, anxiety, pallor, sweating and headache. COMT enzyme catalyzes the O-methylation of the 3-hydroxyl group of catecholamines. The O-methylated derivatives of noradrenaline, adrenaline and dopamine are normetanephrine, metanephrine and 3-methoxytyramine, respectively. The term "metanephrines" is generally used to collectively refer to the first two compounds. Compared to catecholamines, metanephrines are characterized by longer half-life and more stable levels over time. Their superior accuracy for the diagnosis and follow-up of pheochromocytoma and paraganglioma (PPGL) has been widely proved. Excluding patients with PPGL, however, metanephrines can be more broadly considered as reliable markers of the whole sympathetic system activity; therefore, their levels may be hypothesized to be associated to a higher rate of concurrent cardiometabolic complications and, if so, could be useful for the stratification of cardiovascular risk.
Study Type
OBSERVATIONAL
Enrollment
1,380
Division of Endocrinology, Diabetology and Metabolism; University of Turin
Turin, Piedmont, Italy
Presence of left ventricular hypertrophy
The value of urinary metanephrines will be evaluated as a possible predictor of the presence of left ventricular hypertrophy
Time frame: At baseline
Presence of chronic kidney disease
The value of urinary metanephrines will be evaluated as a possible predictor of the presence of chronic kidney disease
Time frame: At baseline
Presence of type 2 diabetes mellitus
The value of urinary metanephrines will be evaluated as a possible predictor of the presence of type 2 diabetes mellitus
Time frame: At baseline
Presence of metabolic syndrome
The value of urinary metanephrines will be evaluated as a possible predictor of the presence of metabolic syndrome
Time frame: At baseline
Systolic blood pressure (SBP)
The value of urinary metanephrines will be evaluated as a possible predictor of systolic blood pressure values (mmHg)
Time frame: At baseline
Diastolic blood pressure (DBP)
The value of urinary metanephrines will be evaluated as a possible predictor of diastolic blood pressure values (mmHg)
Time frame: At baseline
Resting heart rate
The value of urinary metanephrines will be evaluated as a possible predictor of resting heart rate (bpm)
Time frame: At baseline
eGFR
The value of urinary metanephrines will be evaluated as a possible predictor of eGFR values (ml/min, as estimated by CKD-EPI formula)
Time frame: At baseline
Urinary albumin/creatinine ratio
The value of urinary metanephrines will be evaluated as a possible predictor of albumin/creatinine ratio values (mg/mmol)
Time frame: At baseline
Fasting glucose
The value of urinary metanephrines will be evaluated as a possible predictor of fasting glucose values (mg/dl)
Time frame: At baseline
Total cholesterol
The value of urinary metanephrines will be evaluated as a possible predictor of total cholesterol values (mg/dl)
Time frame: At baseline
HDL cholesterol
The value of urinary metanephrines will be evaluated as a possible predictor of HDL cholesterol values (mg/dl)
Time frame: At baseline
LDL cholesterol
The value of urinary metanephrines will be evaluated as a possible predictor of LDL cholesterol values (mg/dl, as estimated by Friedewald formula)
Time frame: At baseline
Triglycerides
The value of urinary metanephrines will be evaluated as a possible predictor of triglycerides values (mg/dl)
Time frame: At baseline
Body Mass Index (BMI)
The value of urinary metanephrines will be evaluated as a possible predictor of BMI values (kg/m2)
Time frame: At baseline
Cardiovascular risk as estimated by Framingham Risk Score (FRS)
The value of urinary metanephrines will be evaluated as a possible predictor of cardiovascular risk as estimated by FRS; FRS is expressed as a percentage, with higher values indicating higher risk; patients in which the risk estimation is not applicable will be excluded from the analysis
Time frame: At baseline
Cardiovascular risk as estimated by Systematic COronary Risk Evaluation (SCORE)
The value of urinary metanephrines will be evaluated as a possible predictor of cardiovascular risk as estimated by SCORE; SCORE is expressed as a percentage, with higher values indicating higher risk; patients in which the risk estimation is not applicable will be excluded from the analysis
Time frame: At baseline
Cardiovascular risk as estimated by Progetto Cuore Score (english translation: "Heart Project Score")
The value of urinary metanephrines will be evaluated as a possible predictor of cardiovascular risk as estimated by Progetto Cuore Score; Progetto Cuore Score is expressed as a percentage, with higher values indicating higher risk; patients in which the risk estimation is not applicable will be excluded from the analysis
Time frame: At baseline
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