Microalbuminuria Is Determined by Systolic and Pulse Pressure Over a 12-Year Period and Related to Peripheral Artery Disease in Normotensive and Hypertensive Subjects: The Three Areas Study in Greece (TAS-GR)

Abstract

Microalbuminuria and peripheral artery disease represent 2 different forms of target organ damage due to raised blood pressure. The aim of this study was to investigate the association between blood pressure with microalbuminuria and the appearance of peripheral artery disease after more than a decade, and moreover, to address whether any relationship exists between microalbuminuria and peripheral disease in a Greek Caucasian population. In 1990, 635 normal subjects were examined and their blood pressure was recorded. Nine and 12 years later, subjects were reexamined and 361 of them (57%) were available at last visit for the determination of microalbuminuria and ankle-arm index. Microalbuminuria was detected in 35/361 (9.7%) and peripheral artery disease in 89/361 (24.7%). Both conditions were statistically correlated with pulse and systolic blood pressure at all time points during the 12-year follow-up period, while the relationship with diastolic and mean arterial pressure existed only for baseline values and was then abolished. Microalbuminuria was statistically correlated to peripheral artery disease (r = -0.460, p = 0.0001). Blood pressure levels seemed to predict the appearance of microalbuminuria and peripheral disease after 12 years. Microvasculature and macrovasculature abnormalities (microalbuminuria and peripheral disease, respectively) showed a significant relationship, suggesting a common pathogenetic mechanism.

Is Longitudinal Pulse Pressure a Better Predictor of 24-Hour Urinary Albumin Excretion Than Other Indices of Blood Pressure?

“…Although, urinary albumin concentration had a stronger association with concurrent PP (β=0.199, P=0.00001) than with concurrent SBP (β=0.164, P=0.005), the associations of urinary albumin concentration with the 4 BP indices measured 3 and 12 years before urinary albumin measurement were inconsistent. 14 Additionally, these associations were not directly compared in that study. 14 …”

“…9 In a cross-sectional study that only included men, 9 Pedrinelli et al found that among the 4 indices of BP, PP was the best predictor of microalbuminuria (UAE≥15 µg/min). In another study, 14 Tsakiris et al found that, after adjusting for age, spot urinary albumin concentration measured in a morning urine sample was significantly associated with concurrent SBP and PP, but not with concurrent DBP or MBP. Although, urinary albumin concentration had a stronger association with concurrent PP (β=0.199, P=0.00001) than with concurrent SBP (β=0.164, P=0.005), the associations of urinary albumin concentration with the 4 BP indices measured 3 and 12 years before urinary albumin measurement were inconsistent.…”

Increases in Central Aortic Impedance Precede Alterations in Arterial Stiffness Measures in Type 1 Diabetes

“…A similar relationship between pulse pressure or measures of central aortic stiffness and urine albumin excretion has been noted previously in type 2 diabetes (7,32,33), whereas urine albumin does not necessarily correlate with hyperinsulinemia (34), again suggesting the importance of hemodynamic changes in the development of renal microvascular disease. The link between pulse pressure or central arterial stiffness and urine albumin levels has also been demonstrated in patients with hypertension (16,(35)(36)(37)(38)(39)(40)(41) and in healthy adults (42,43). In addition to damaging microvessels, the higher degrees of pressure pulsatility seen in type 1 diabetes may also increase tensile and shear stresses in the large and medium vessels and could contribute to early atherogenesis.…”

Relationship between wave reflection and renal damage in hypertensive patients

“…Arterial stiffening is also associated with microvascular dysfunction [6] and with heart [7], brain [8][9][10], and renal [11,12] damage. Furthermore, it has been shown that high pulse pressure (particularly at the central level), whose arterial stiffness is a major determinant, is associated with brain [9] and renal [13][14][15] damage.…”