URINARY ALBUMIN AND N-ACETYL-BETA-D-GLUCOSAMINIDASE EXCRETIONS IN MILD HYPERTENSION

Renal effects of mild hypertension and therapy have not been establish ed. Since urinary albumin and N-acetyl-beta-D-glucosaminidase excretio ns reflect renal effects of hypertension, they were related to blood p ressure, other cardiovascular risk factors, cardiac target organ effec ts, and response to therapy in mild hypertension (diastolic blood pres sure 85-99 mm Hg). Participants were from two clinics of the Treatment of Mild Hypertension Study (TOMHS), a multicenter randomized, double- blind, controlled trial. Participants received nutritional-hygienic th erapy and one of five active drugs or placebo. Urinary albumin and N-a cetyl-beta-D-glucosaminidase excretions were assessed prospectively us ing office ''spot'' collections from one clinic (n = 213) and retrospe ctively using overnight collections from the other clinic (n = 210). R elationships were determined between protein excretions and blood pres sure, age, gender, race, blood glucose, cholesterol concentrations, an d indices of body mass and left ventricular mass and function at basel ine. Treatment effects were assessed after 3 to 12 months. Spot and ov ernight albumin excretions related positively to baseline systolic blo od pressure by univariate analyses. Spot albumin excretion related pos itively to systolic blood pressure, age, creatinine clearance, and lef t ventricular function while overnight albumin excretion related posit ively to left ventricular mass and female gender by multiple regressio n analyses. Spot, but not overnight, albumin excretion declined signif icantly with active drug therapy. N-acetyl-beta-D-glucosaminidase excr etion did not relate to blood pressure or decline with therapy. The co mbined results suggest albumin excretion correlates with blood pressur e, decreases with antihypertensive drug therapy, and is associated wit h greater left ventricular function and mass, as well as glomerular fi ltration rate, even at mild levels of hypertension.