MICROALBUMINURIA AND ITS RELATION TO CARDIOVASCULAR-DISEASE AND RISK-FACTORS - A POPULATION-BASED STUDY OF 1254 HYPERTENSIVE INDIVIDUALS

Microalbuminuria has been proposed as a potential atherosclerotic risk factor in hypertensive individuals. The aim of this cross-sectional p opulation study was to analyse whether microalbuminuria is related to a higher prevalence of cardiovascular disease, and a more atherogenic risk profile, and reversely related to the use of antihypertensive dru gs. In a major health screening at the State University Hospital in Co penhagen, including urinary albumin excretion, glomerular filtration r ate, blood pressure (BP), electrocardiogram, body mass index, plasma l ipoproteins, fibrinogen, and albumin, and information regarding a hist ory of acute myocardial infarction, smoking, and antihypertensive drug s, 1254 participants without diabetes mellitus or renal/urinary tract disease had arterial hypertension. Age range was 30-70 years. Microalb uminuria (nocturnal urinary albumin excretion >15 mu g/min) occurred i n 5%, and cardiovascular disease (previous acute myocardial infarction or electrocardiographic Q-waves) also in 5% of the study population. Microalbuminuric hypertensive subjects were characterized by higher ag e and systolic BP, and a male predominance, as compared to normoalbumi nuric hypertensive subjects. The frequency of cardiovascular disease w as similar in the two groups. In contrast, when analysed as a continuo us variable, a one unit increase in the logarithmically transformed ur inary albumin excretion significantly increased the likelihood of card iovascular disease (odds ratio [95% confidence interval] 1.32 (1.02-1. 70); P < 0.05), and this relation was independent of age, sex, and con ventional atherosclerotic risk factors. Participants who were effectiv ely treated with antihypertensive drugs did not have a lower urinary a lbumin excretion than insufficiently treated or untreated participants . It is concluded that slightly elevated albumin excretion in the urin e is not only a pressure-dependent functional phenomenon in the glomer ular vessel walls, but associated with permanent atherosclerotic abnor malities in the entire vascular system.