Böhm Michael, Thoenes Martin, Danchin Nicolas, Reil Jan C, Volpe Massimo
Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University of the Saarland, 66421, Homburg, Saar, Germany,
High Blood Press Cardiovasc Prev. 2008 Oct;15(4):217-24. doi: 10.2165/0151642-200815040-00001. Epub 2013 Jan 22.
Microalbuminuria (MAU) is a highly predictive, sensitive, inexpensive and easily repeatable marker of cardiovascular risk and all-cause mortality in hypertensive patients. The international, observational, practice-based study i-SEARCH (Survey for Evaluating Microalbuminuria Routinely by Cardiologists in patients with Hypertension) was designed to assess the frequency with which MAU occurred in a large outpatient population who were currently treated or newly diagnosed with hypertension and were under professional care. The primary aim of the study was to define the prevalence of MAU in hypertensive outpatients attending a cardiologist or internist (i-SEARCH A) and to compare hypertensive outpatients with or without coronary artery disease (i-SEARCH B). A secondary objective was to establish a correlation between MAU and known cardiovascular risk factors. A total of 21 050 patients from 26 countries were included in the primary analysis. Overall, this study demonstrated a very high worldwide prevalence (58.4%) of MAU in high-risk cardiovascular patients, but with a considerable variation across countries. MAU was more prevalent in patients with coronary artery disease than in those without. It was also significantly related to the presence of specific predictors, including male gender, abnormally high waist circumference, increased blood pressure levels (systolic ≥120 mmHg, diastolic ≥100 mmHg), creatinine clearance ≥50 mL/min, or clinical conditions such as diabetes mellitus, congestive heart failure, history of cerebral pathology, and peripheral arterial disease. Since the presence of MAU reflects long-term detrimental effects on the cardiovascular system, these results indicate the high, and in many cases hidden, burden of cardiovascular diseases among the hypertensive patients seen by cardiologists. This article discusses the main results of the study and the potential implications of ongoing analyses included in the core clinical study programme.
微量白蛋白尿（MAU）是高血压患者心血管风险和全因死亡率的一个具有高度预测性、敏感性、低成本且易于重复检测的指标。国际、基于观察性实践的研究i-SEARCH（心血管科医生对高血压患者常规评估微量白蛋白尿的调查）旨在评估在目前正在接受治疗或新诊断为高血压且接受专业护理的大量门诊患者中MAU出现的频率。该研究的主要目的是确定在看心血管科医生或内科医生的高血压门诊患者中MAU的患病率（i-SEARCH A），并比较有或无冠状动脉疾病的高血压门诊患者（i-SEARCH B）。次要目标是建立MAU与已知心血管危险因素之间的相关性。初步分析纳入了来自26个国家的21050名患者。总体而言，这项研究表明，在高风险心血管患者中，MAU在全球范围内的患病率非常高（58.4%），但各国之间存在相当大的差异。MAU在有冠状动脉疾病的患者中比在无冠状动脉疾病的患者中更普遍。它还与特定预测因素的存在显著相关，包括男性、腰围异常高、血压水平升高（收缩压≥120 mmHg，舒张压≥100 mmHg）、肌酐清除率≥50 mL/min，或糖尿病、充血性心力衰竭、脑部疾病史和外周动脉疾病等临床情况。由于MAU的存在反映了对心血管系统的长期有害影响，这些结果表明心血管科医生诊治的高血压患者中存在着高负担的心血管疾病，而且在许多情况下这种负担是隐匿的。本文讨论了该研究的主要结果以及核心临床研究计划中正在进行的分析的潜在意义。
