Arterial Hypertension, Microalbuminuria, and Risk of Ischemic Heart Disease

Abstract

Abstract-Albumin excretion in urine is positively correlated with the presence of ischemic heart disease and atherosclerotic risk factors. We studied prospectively whether a slight increase of urinary albumin excretion, ie, microalbuminuria, adds to the increased risk of ischemic heart disease among hypertensive subjects. In 1983 and 1984, blood pressure, urinary albumin/creatinine concentration ratio, plasma total and HDL cholesterol levels, body mass index, and smoking status were obtained in a population-based sample of 2085 subjects, aged 30 to 60 years, who were free from ischemic heart disease, diabetes mellitus, and renal or urinary tract disease. Untreated arterial hypertension or borderline hypertension was present in 204 subjects, who were followed until 1993 by the National Hospital and Death Certificate Registers with respect to development of ischemic heart disease. During 1978 person-years, 18 (9%) of the hypertensive subjects developed ischemic heart disease. Microalbuminuria, defined as a urinary albumin/creatinine ratio above the upper decile (1.07 mg/mmol), was the strongest predictor of ischemic heart disease, with an unadjusted relative risk of 4.2 (95% CI 1.5 to 11.9, Pϭ0.006) and a relative risk of 3.5 (95% CI 1.0 to 12.1, Pϭ0.05) when adjusted for all other atherosclerotic risk factors, including age and gender. In conclusion, microalbuminuria confers a 4-fold increased risk of ischemic heart disease among hypertensive or borderline hypertensive subjects. Urinary albumin excretion should be measured regularly in a hypertension clinic, and a rigorous control of blood pressure and of other atherosclerotic risk factors is recommended in hypertensive patients with microalbuminuria. Key Words: atherosclerosis Ⅲ hypertension, arterial Ⅲ ischemia Ⅲ microalbuminuria Ⅲ heart A rterial hypertension is, in some patients, associated with a subclinical increase of the albumin excretion in the urine, ie, microalbuminuria, in spite of preserved renal function. 1,2 In hypertensive subjects, microalbuminuria has often been related to an excess of atherosclerotic cardiovascular disease, 2,3 which is more frequent in the hypertensive population, 4 and to an increased level of atherosclerotic risk markers. [5][6][7] In populations of diabetic patients as well as in the general population, microalbuminuria independently precedes atherosclerotic cardiovascular disease, 8 -12 but this has never been established among hypertensive subjects.In the present study, we describe a 10-year follow-up analysis of all subjects with untreated arterial hypertension or borderline hypertension identified within the World Health Organization (WHO) Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study in Denmark, 1983 and 1984. 13,14 Arterial hypertension was defined according to the WHO criteria. The definition of microalbuminuria has been used in previous studies by our group [15][16][17][18][19][20][21][22] and follows a recommendation by Mogensen, 23 ie, a urinary albumin excretion ab...

Microalbuminuria is associated with unfavourable cardiac geometric adaptations in essential hypertensive subjects

“…1,2,4-6 Accordingly, it was recently established that microalbuminuria confers a fourfold increased risk of ischaemic heart disease among hypertensive or bordeline hypertensive subjects. 1 The described association of increased UAE with LV hypertrophy 6,8 may explain some of the prognostic significance of microalbuminuria. Indeed, in our study, higher indexed LV mass was found in microalbuminuric subjects than in normoalbuminuric individuals.…”

“…1,2 Indeed, it is well established that microalbuminuria can be considered predictive of the development of overt proteinuria and of cardiovascular mortality in diabetic patients. 3 The same adverse prognostic conclusion seems to emerge from recent research in tively correlated to LVMI (r = 0.46, P Ͻ 0.001) and relative wall thickness (r = 0.47, P Ͻ 0.001).…”

Creatinine clearance and signs of end-organ damage in primary hypertension

“…1,2 The pathophysiological mechanisms underlying this association have not yet been fully elucidated, although they likely involve a number of different factors. In fact, it has been shown that a moderate reduction in glomerular filtration rate is associated with a cluster of haemodynamic and proatherogenic abnormalities, such as increased blood pressure (BP) load, insulin resistance, dyslipidaemia, hyperhomocysteinaemia, endothelial dysfunction, and systemic inflammation, which, in turn, may concur to foster the development of cardiac and vascular complications.…”

Microalbuminuria is an integrated marker of subclinical organ damage in primary hypertension

“…3,4 Recently, it was proven to be a predictor of cardiovascular morbidity and mortality in long term longitudinal studies. 5,6 Even though the pathogenesis of increased urinary albumin excretion (UAE) is at present still unclear, this abnormality has been proposed as a useful integrated marker of target organ damage (TOD) and increased cardiovascular risk. 7 However, routine evaluation of Mi is not recommended by international guidelines as part of the diagnostic work-up of every hypertensive patient and its potential diagnostic power has not yet been fully exploited in clinical practice.…”