Preventive Medical Center and Division of Hypertension, Tohoku Rosai Hospital, Sendai, Japan.
J Hypertens. 2013 Apr;31(4):798-804. doi: 10.1097/HJH.0b013e32835e2146.
Although hypertension is a well known risk factor for microalbuminuria, it is unclear whether blood pressure less than 140/90 mmHg could be a risk for microalbuminuria. We assessed the relationship between baseline blood pressure and the future onset of microalbuminuria in the general population.
We studied 2603 town inhabitants of Watari, located in the southeastern part of Miyagi prefecture, Japan. Demographic data, medical history, sitting blood pressure, fasting blood chemistry, and urinary albumin-creatinine ratio were measured at baseline and were followed annually during the next 3 years.
Among 2338 individuals who were normoalbuminuric at baseline (albumin-creatinine ratio <30 mg/g Cr), 161 developed microalbuminuria (albumin-creatinine ratio 30-299 mg/g Cr) during a mean follow-up period of 2.4 years. Incident microalbuminuria patients were older (63.7 ± 8.6 vs. 61.4 ± 10.5 years; P < 0.01), included fewer men (31.1 vs. 40.1%; P < 0.05), had a greater BMI (23.8 ± 3.6 vs. 23.1 ± 3.1 kg/m²; P < 0.01), higher blood pressures (133.5 ± 18.1/75.8 ± 11.9 vs. 127.6 ± 18.1/73.4 ± 11.0 mmHg; P < 0.01 for both systolic and diastolic), higher triglycerides (median 1.18 vs. 1.02 mmol/l; P < 0.01), higher fasting blood glucose (median 5.05 vs. 4.94 mmol/l; P < 0.01), higher urinary albumin excretion (median 13.0 vs. 5.9 mg/g Cr; P < 0.001), and lower serum creatinine concentrations (59.2 ± 12.8 vs. 61.4 ± 13.2 μmol/l; P < 0.05) compared to persistent normoalbuminuric individuals. Multivariate Cox proportional hazards analysis including all covariates revealed that only baseline urinary albumin excretion was an independent predictor for future microalbuminuria, whereas high-normal DBP, triglyceride, and fasting blood glucose concentrations were all significant predictors in the model excluding urinary albumin excretion.
High-normal DBP associated with metabolic disorders could initiate glomerular damage, leading to future microalbuminuria.
尽管高血压是微量白蛋白尿的一个众所周知的危险因素，但血压低于 140/90mmHg 是否会增加微量白蛋白尿的风险尚不清楚。我们评估了一般人群中基线血压与未来微量白蛋白尿发病之间的关系。
我们研究了位于日本宫城县东南部的 Watari 的 2603 名城镇居民。在基线时测量人口统计学数据、病史、坐位血压、空腹血液化学和尿白蛋白/肌酐比值，并在接下来的 3 年内每年进行随访。
在 2338 名基线时尿白蛋白正常（白蛋白/肌酐比值<30mg/gCr）的个体中，161 名在平均 2.4 年的随访期间发展为微量白蛋白尿（白蛋白/肌酐比值 30-299mg/gCr）。微量白蛋白尿患者年龄更大（63.7±8.6 岁 vs. 61.4±10.5 岁；P<0.01），男性比例更低（31.1% vs. 40.1%；P<0.05），BMI 更高（23.8±3.6kg/m² vs. 23.1±3.1kg/m²；P<0.01），血压更高（133.5±18.1/75.8±11.9mmHg vs. 127.6±18.1/73.4±11.0mmHg；收缩压和舒张压均 P<0.01），甘油三酯水平更高（中位数 1.18mmol/l vs. 1.02mmol/l；P<0.01），空腹血糖水平更高（中位数 5.05mmol/l vs. 4.94mmol/l；P<0.01），尿白蛋白排泄量更高（中位数 13.0mg/gCr vs. 5.9mg/gCr；P<0.001），血清肌酐浓度更低（59.2±12.8μmol/l vs. 61.4±13.2μmol/l；P<0.05）。包括所有协变量的多变量 Cox 比例风险分析显示，只有基线时的尿白蛋白排泄量是未来微量白蛋白尿的独立预测因素，而高正常的 DBP、甘油三酯和空腹血糖浓度在排除尿白蛋白排泄量的模型中都是显著的预测因素。
与代谢紊乱相关的高正常 DBP 可能导致肾小球损伤，从而导致未来的微量白蛋白尿。
