Higher Levels of Albuminuria within the Normal Range Predict Incident Hypertension

• Published in: Journal of the American Society of Nephrology Vol. 19; no. 10; pp. 1983 - 1988
• Main Authors: Forman, John P., Fisher, Naomi D.L., Schopick, Emily L., Curhan, Gary C.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.10.2008; American Society of Nephrology
• Subjects: Adult; Age Factors; Albuminuria - complications; Albuminuria - urine; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Case-Control Studies; Clinical Epidemiology; Cohort Studies; Creatinine - urine; Female; Humans; Hypertension - epidemiology; Hypertension - urine; Incidence; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Reference Values; Regression Analysis; Risk Factors; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Human; Hypertension; Nephrology; Urinary system disease; Risk factor; Cardiovascular disease; Urology; Proteinuria
• ISSN: 1046-6673; 1533-3450; 1533-3450
• DOI: 10.1681/ASN.2008010038

Higher levels of albumin excretion within the normal range are associated with cardiovascular disease in high-risk individuals. Whether incremental increases in urinary albumin excretion, even within the normal range, are associated with the development of hypertension in low-risk individuals is unknown. This study included 1065 postmenopausal women from the first Nurses' Health Study and 1114 premenopausal women from the second Nurses' Health Study who had an albumin/creatinine ratio <25 mg/g and who did not have diabetes or hypertension. Among the older women, 271 incident cases of hypertension occurred during 4 yr of follow-up, and among the younger women, 296 incident cases of hypertension occurred during 8 yr of follow-up. Cox proportional hazards regression was used to examine prospectively the association between the albumin/creatinine ratio and incident hypertension after adjustment for age, body mass index, estimated GFR, baseline BP, physical activity, smoking, and family history of hypertension. Participants who had an albumin/creatinine ratio in the highest quartile (4.34 to 24.17 mg/g for older women and 3.68 to 23.84 mg/g for younger women) were more likely to develop hypertension than those who had an albumin/creatinine ratio in the lowest quartile (hazard ratio 1.76 [95% confidence interval 1.21 to 2.56] and hazard ratio 1.35 [95% confidence interval 0.97 to 1.91] for older and younger women, respectively). Higher albumin/creatinine ratios, even within the normal range, are independently associated with increased risk for development of hypertension among women without diabetes. The definition of normal albumin excretion should be reevaluated.