Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Nephrol Dial Transplant. 2012 Oct;27 Suppl 3(Suppl 3):iii58-64. doi: 10.1093/ndt/gfr200. Epub 2011 May 17.
Urine albumin excretion in the high normal range [urine albumin to creatinine ratio (UACR) 10-29 mg/g)] predicts hypertension in European-origin populations. However, the prognostic significance of UACR in the high normal range for incident hypertension is unclear in Indo-Asians. The objective of this study was to examine the relationship of normal to high normal levels of UACR and incident hypertension.
We conducted a nested cohort study within a cluster randomized controlled trial in Pakistan on 1272 normotensive non-diabetic adults aged ≥ 40 years with UACR <30 mg/g. Incident hypertension was defined as new onset of systolic blood pressure (SBP) ≥ 140 mmHg or diastolic ≥ 90 mmHg or initiation of antihypertensive therapy.
A total of 920 (72.3%) participants completed the 2-year final follow-up. During this time, 105 (11.4%) developed incident hypertension. In the multivariable model, the odds [95% confidence interval (CI)] for incident hypertension were 2.45(1.21-4.98) for those in the fourth (top) quartile (≥ 6.1 mg/g) and 2.12 (1.04-4.35) in the third quartile (3.8-6.1 mg/g) compared to those in the lowest quartile (<2.8 mg/g). In addition, a significant interaction between UACR and baseline SBP was observed suggesting that the odds (95% CI) of incident hypertension with UACR were greater at lower baseline SBP (interaction P = 0.044).
High normal levels of albuminuria as measured by UACR predict hypertension in non-diabetic Indo-Asians, and this relationship may be enhanced in individuals with low baseline SBP. Further research is needed to assess the clinical applicability of these findings.
尿白蛋白排泄量处于正常高值范围[尿白蛋白与肌酐比值（UACR）10-29mg/g]可预测欧洲人群发生高血压。然而，在印度-亚洲人群中，UACR 处于正常高值范围对高血压事件的预测意义尚不清楚。本研究旨在探讨 UACR 的正常到正常高值与高血压事件的关系。
我们在巴基斯坦进行了一项嵌套队列研究，纳入了 1272 名年龄≥40 岁、UACR<30mg/g 的非糖尿病、血压正常的成年人，这些人参加了一项随机对照试验。高血压的定义为收缩压（SBP）≥140mmHg 或舒张压≥90mmHg 或开始降压治疗。
共有 920 名（72.3%）参与者完成了 2 年的最终随访。在此期间，有 105 名（11.4%）发生了高血压事件。在多变量模型中，第四（最高）四分位（≥6.1mg/g）的参与者发生高血压的比值比（95%置信区间）为 2.45（1.21-4.98），第三四分位（3.8-6.1mg/g）为 2.12（1.04-4.35），与最低四分位（<2.8mg/g）相比。此外，还观察到 UACR 和基线 SBP 之间存在显著的交互作用，这表明 UACR 与高血压的比值比（95%CI）在较低的基线 SBP 时更高（交互 P=0.044）。
UACR 测定的白蛋白尿正常高值可预测非糖尿病印度-亚洲人群的高血压，并且这种关系在基线 SBP 较低的个体中可能更强。需要进一步的研究来评估这些发现的临床适用性。
