AMBULATORY BLOOD-PRESSURE AND URINARY ALBUMIN EXCRETION IN CLINICALLYHEALTHY-SUBJECTS

A slightly elevated urinary albumin excretion rate (UAER) is a predict or of atherosclerotic cardiovascular disease. The mechanism is unknown , but moderate office blood pressure elevation has been demonstrated a s part of a clustering of known atherosclerotic risk factors in subjec ts with elevated UAER. Because 24-hour ambulatory blood pressure is a superior predictor of hypertensive target organ involvement, we aimed to investigate blood pressure profile in clinically healthy subjects w ith elevated UAER. Ambulatory blood pressure monitoring was performed with a portable recorder in 27 subjects with an elevated UAER (>6.6 mu g/min, overnight urine collection) and 46 normoalbuminuric control su bjects. Mean+/-SD systolic and diastolic ambulatory blood pressures (2 4-hour) were significantly higher in subjects with elevated UAER than in normoalbuminuric controls (134+/-12 versus 128+/-11 mm Hg and 78+/- 7 versus 75+/-6 mm Hg, P<0.05), as were systolic and diastolic blood p ressure loads [median (range): 42% (6 to 94%) versus 23% (1 to 89%) an d 20% (0 to 68%) versus 6% (0 to 62%), P<0.05]. The circadian variatio n of blood pressure was normal in subjects with elevated UAER. However , the increased urinary loss of albumin could not be solely related to the higher blood pressure. In conclusion, apparently healthy subjects with elevated UAER had slightly but significantly higher 24-hour syst olic and diastolic blood pressure levels in addition to increased bloo d pressure loads but normal circadian variation. The demonstrated diff erences in blood pressure may offer a partial explanation for the asso ciation between elevated urinary albumin excretion and atherosclerotic cardiovascular risk.