Redon Josep, Rovira Eduardo, Miralles Amparo, Julve Raul, Pascual Jose M
Hypertension Clinic, Hospital Clinico, University of Valencia, Valencia, Spain.
Hypertension. 2002 Mar 1;39(3):794-8. doi: 10.1161/hy0302.105209.
The objective of the study was to assess the factors related to the occurrence of microalbuminuria during the follow-up of a young adult group with essential hypertension that had not been previously treated. Normo-albuminuric essential hypertensives, <50 years old, who had not been previously treated with antihypertensive drugs and who did not have diabetes mellitus were included. After the initial evaluation, patients were treated using only nonpharmacological measures (n=62), beta-blockers (n=38), ACE inhibitors (n=64), calcium channel blockers (n=8), and several classes (n=15). Measurements were taken for office blood pressure, biochemical profile, and 24-hour urinary albumin excretion at the beginning of the study and were measured yearly during an average of 2.7+/-1.2 years of follow-up. Among the 187 patients included, 22 (11,7%) developed microalbuminuria (progressors, 4.4/100 patients/y). No differences were present between progressors and those who remained normo-albuminuric (nonprogressors) in terms of age, gender, body mass index, disease duration, blood pressure values, biochemical profile, familial history of diabetes or hypertension, smoking habits, or the presence of EKG left ventricular hypertrophy. The group with the lowest progression rate was the patients treated with ACE inhibitors (n=5; 2.9/100 patients/y), followed by the diet group (n=5; 3.3/100 patients/y) and the beta-blockers group (n=5; 4.1/100 patients/y). When we excluded patients treated with calcium channel blockers or those who changed over time between different classes of treatment, no significant differences in the incidence of microalbuminuria were observed among the groups. Progressors showed higher slopes of fasting glucose (4.78+/-11.4 versus 0.50+/-6.8 mg/y, P<0.02) and uric acid (0.58+/-0.93 versus 0.05+/-1.10 mg/y, P<0.03) compared with the slopes of nonprogressors. Both the slopes for glucose and systolic blood pressure over time were associated independently with the slope of the logarithm of urinary albumin excretion when adjusted for age, gender, and treatment groups. Cox proportional hazard model for progression of microalbuminuria showed that baseline urinary albumin excretion (risk ratio [RR]=1.06; confidence interval [CI] 95%, 1.01 to 1.11), slope for systolic blood pressure (RR=1.11; CI 95%, 1.03 to 1.20), and slope for glucose (RR=1.08; CI 95%, 1.03 to 1.14) were independently associated to the development of microalbuminuria. In conclusion, in a group of young adults with essential hypertension that had not been previously treated, the main factors influencing the occurrence of microalbuminuria during antihypertensive treatment were the values of microalbuminuria at baseline and the slopes for systolic blood pressure and fasting glucose.
本研究的目的是评估在一组未经治疗的青年原发性高血压患者随访期间与微量白蛋白尿发生相关的因素。纳入年龄<50岁、既往未接受过抗高血压药物治疗且无糖尿病的正常白蛋白尿原发性高血压患者。初始评估后，患者仅采用非药物措施治疗（n = 62）、β受体阻滞剂治疗（n = 38）、ACE抑制剂治疗（n = 64）、钙通道阻滞剂治疗（n = 8）以及多种药物联合治疗（n = 15）。在研究开始时测量诊室血压、生化指标和24小时尿白蛋白排泄量，并在平均2.7±1.2年的随访期间每年进行测量。在纳入的187例患者中，22例（11.7%）出现微量白蛋白尿（进展者，4.4/100患者/年）。进展者与仍为正常白蛋白尿者（非进展者）在年龄、性别、体重指数、病程、血压值、生化指标、糖尿病或高血压家族史、吸烟习惯或心电图左心室肥厚方面无差异。进展率最低的组是接受ACE抑制剂治疗的患者（n = 5；2.9/100患者/年），其次是饮食组（n = 5；3.3/100患者/年）和β受体阻滞剂组（n = 5；4.1/100患者/年）。当我们排除接受钙通道阻滞剂治疗的患者或随时间在不同治疗类别之间转换的患者时，各治疗组间微量白蛋白尿的发生率无显著差异。与非进展者相比，进展者的空腹血糖斜率（4.78±11.4对0.50±6.8 mg/年，P<0.02）和尿酸斜率（0.58±0.93对0.05±1.10 mg/年，P<0.03）更高。在调整年龄、性别和治疗组后，血糖和收缩压随时间的斜率均与尿白蛋白排泄量对数的斜率独立相关。微量白蛋白尿进展的Cox比例风险模型显示，基线尿白蛋白排泄量（风险比[RR]=1.06；95%置信区间[CI]，1.
