Wachtell Kristian, Ibsen Hans, Olsen Michael H, Borch-Johnsen Knut, Lindholm Lars H, Mogensen Carl Erik, Dahlöf Björn, Devereux Richard B, Beevers Gareth, de Faire Ulf, Fyhrquist Frej, Julius Stevo, Kjeldsen Sverre E, Kristianson Krister, Lederballe-Pedersen Ole, Nieminen Markku S, Okin Peter M, Omvik Per, Oparil Suzanne, Wedel Hans, Snapinn Steven M, Aurup Peter
Department of Medicine, Glostrup University Hospital, Glostrup, Denmark.
Ann Intern Med. 2003 Dec 2;139(11):901-6. doi: 10.7326/0003-4819-139-11-200312020-00008.
Several studies have shown that albuminuria is associated with increased risk for fatal and nonfatal cardiovascular events, independent of conventional risk factors. The partition values for urine albumin-creatinine ratio (UACR) used to identify microalbuminuria have been based on studies that predicted risk in diabetic patients.
To determine whether the relation between albuminuria and cardiovascular risk can be used to predict cardiovascular morbidity and mortality in hypertensive patients.
Multicenter cohort study derived from a randomized, controlled trial.
8206 patients with stage II or III hypertension randomly assigned to double-blind therapy with losartan or atenolol. Follow-up was 39 122 patient-years.
Renal glomerular permeability evaluated by UACR.
In nondiabetic hypertensive patients with left ventricular hypertrophy, the risk for the composite cardiovascular end point increased continuously as albuminuria increased (P < 0.001 for trend). There was no specific threshold for increased risk. For every 10-fold increase in UACR, hazard ratios in nondiabetic patients increased as follows: composite end point, by 57% (95% CI, 40.6% to 75.0%); cardiovascular mortality, by 97.7% (CI, 66.5% to 235%); all-cause mortality, by 75.2% (CI, 54.0% to 99.4%); stroke, by 51.0% (CI, 28.8% to 76.9%); and myocardial infarction, by 45% (CI, 19.9% to 75.4%) (P < 0.001 for all comparisons). Values were similar in diabetic patients, although for myocardial infarction the trend was weaker and not significant.
Increased UACR resulted in increasing risk for cardiovascular morbidity and mortality among hypertensive patients with left ventricular hypertrophy. We found no thresholds or plateaus. Risk increases at much lower UACR values than has been reported among diabetic patients.
多项研究表明，蛋白尿与致命和非致命心血管事件风险增加相关，且独立于传统风险因素。用于识别微量白蛋白尿的尿白蛋白肌酐比值（UACR）划分值是基于预测糖尿病患者风险的研究得出的。
确定蛋白尿与心血管风险之间的关系是否可用于预测高血压患者的心血管发病率和死亡率。
源自一项随机对照试验的多中心队列研究。
8206例II期或III期高血压患者，随机分配接受氯沙坦或阿替洛尔双盲治疗。随访时间为39122患者年。
通过UACR评估肾小球通透性。
在伴有左心室肥厚的非糖尿病高血压患者中，随着蛋白尿增加，复合心血管终点风险持续增加（趋势P<0.001）。风险增加无特定阈值。UACR每增加10倍，非糖尿病患者的风险比增加如下：复合终点增加57%（95%CI，40.6%至75.0%）；心血管死亡率增加97.7%（CI，66.5%至235%）；全因死亡率增加75.2%（CI，54.0%至99.4%）；中风增加51.0%（CI，28.8%至76.9%）；心肌梗死增加45%（CI，19.9%至75.4%）（所有比较P<0.001）。糖尿病患者的情况相似，尽管心肌梗死的趋势较弱且无统计学意义。
UACR升高导致伴有左心室肥厚的高血压患者心血管发病率和死亡率风险增加。我们未发现阈值或平台期。与糖尿病患者相比，在低得多的UACR值时风险就会增加。
