USEFULNESS OF MICROALBUMINURIA IN PREDICTING CARDIOVASCULAR MORTALITYIN TREATED HYPERTENSIVE MEN WITH AND WITHOUT DIABETES-MELLITUS

In the present study we report on the predictive power of microalbumin uria for total and cardiovascular mortality in a prospective study (me an follow up 6.3 years) of treated hypertensive men, aged 50 to 72 yea rs, with (n = 94) and without (n = 345) maturity onset diabetes mellit us. Thirty-three [35.1%) of the hypertensive patients with diabetes me llitus died during the follow-up period compared with 57 patients (16. 5%) in the hypertensive group without diabetes mellitus (p <0.0002). I n those with diabetes mellitus and hypertension, a log-rank test revea led a lower cardiovascular mortality in the normoalbuminuric group com pared with both the microalbuminuric (p = 0.035) and the mocroalbuminu ric group (p = 0.002). The logarithm of urinary albumin excretion was a predictor of both total (p = 0.009) and cardiovascular (p = 0.001) m ortality during the followup period using Cox regression analysis. Thi s relation remained significant even after adjustment for other risk f actors. HbA1(c) was also an independent predictor of total and cardiov ascular mortality. In patients without diabetes mellitus, the small gr oup of patients with macroalbuminuria had a markedly increased cardiov ascular mortality compared with both the microalbuminuric (p <0.0001) and the normoalbuminuric groups (p <0.0001). No difference was observe d between the normoalbuminuric and the microalbuminuric groups. Smokin g at entry and concomitant cardiovascular disease at entry were indepe ndent predictors of cardiovascular mortality in these patients, We con clude that microalbuminuria was an independent predictor for cardiovas cular mortality in treated hypertensive men with maturity onset diabet es mellitus, Macroalbuminuria, but not microalbuminuria, predicted car diovascular mortality in nondiabetic treated hypertensive men. (C) 199 7 by Excerpta Medica, Inc.