Pulse pressure and isolated systolic hypertension: Association with microalbuminuria

Background The long-term risk of end-stage renal disease is high in persons with isolated systolic hypertension, that is, those with an elevation of p ulse pressure and not of diastolic pressure. Other data suggest that pulse pressure is a predictor of the hypertension-induced organ damage. Microalbu minuria is considered an early sign of glomerular damage caused by hyperten sion. The study shows the relationship of pulse pressure and isolated systo lic hypertension to microalbuminuria in nondiabetic subjects. Methods. This is a cross sectional analysis for a population sample of 677 men and 890 women, aged 45 to 64 years, who were without diabetes mellitus and macroalbuminuria. Data collection included: overnight urinary albumin a nd creatinine excretion; fasting plasma glucose, cholesterol, and creatinin e; creatinine clearance; and blood pressure, weight, height, medical histor y, and smoking habit. Pulse pressure was calculated as systolic minus diast olic pressure. Isolated systolic hypertension was defined as systolic press ure greater than or equal to 140 mm Hg in persons not on antihypertensive d rugs and with diastolic pressure <90 mm Hg. Microalbuminuria was defined as urinary albumin excretion greater than or equal to 20 mu g/min. Results. Pulse pressure and isolated systolic hypertension were significant ly related to urinary albumin excretion and the prevalence of microalbuminu ria in univariate and multivariate analyses. Controlling for gender and oth er variables, the risk of microalbuminuria was 1.71 with a 15 mm Hg higher pulse pressure (95% CI, 1.31 to 2.22) and 4.95 in the presence of isolated systolic hypertension (95% CI, 3.15 to 7.76). Conclusions. In nondiabetic, middle-aged adults, pulse pressure and isolate d systolic hypertension are directly related to microalbuminuria, independe nt of diastolic pressure and other correlates.