1] Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA [2] Institute for Quantitative Biology, East Tennessee State University, Johnson City, TN, USA.
Hypertens Res. 2013 Dec;36(12):1100-6. doi: 10.1038/hr.2013.87. Epub 2013 Aug 15.
Accumulating evidence reveals that albuminuria may exacerbate uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of albuminuria with uncontrolled BP among diagnosed hypertensives have not been evaluated. A total of 6147 diagnosed hypertensive subjects aged ≥ 18 years were collected from the National Health and Nutrition Examination Survey 1999-2008 with stratified multistage sampling designs. Odds ratios (ORs), relative ORs and 95% confidence intervals (CIs) in uncontrolled BP, and the different effects of microalbuminuria and macroalbuminuria on continuous BP were estimated using weighted logistic models and linear regression models. Hypertensive subjects with microalbuminuria and macroalbuminuria were more likely to have uncontrolled BP and higher average systolic BP (SBP) in all individual racial groups. Microalbuminuria was associated with isolated uncontrolled SBP in non-Hispanic blacks and whites, and macroalbuminuria was associated with isolated uncontrolled SBP and diastolic BP (DBP) and high average DBP only in non-Hispanic blacks. Compared with non-Hispanic whites, non-Hispanic blacks and Mexicans had lower associations of microalbuminuria with uncontrolled BP (relative OR = 0.68, 95% CI = 0.48-0.97 for blacks vs whites; relative OR = 0.62, 95% CI = 0.42-0.93 for Mexicans vs. whites) and isolated uncontrolled SBP (relative OR = 0.62, 95% CI = 0.43-0.90 for blacks vs. whites; relative OR = 0.45, 95% CI = 0.29-0.71 for Mexicans vs. whites). The association of microalbuminuria with uncontrolled BP was lower in non-Hispanic blacks and Mexicans than in non-Hispanic whites. Health providers need to improve care for mildly elevated albumin excretion rates in non-Hispanic white hypertensive patients while maintaining the quality of care in non-Hispanic blacks and Mexicans.
越来越多的证据表明，白蛋白尿可能会使高血压患者的血压控制更加困难。然而，在已确诊的高血压患者中，白蛋白尿与血压控制不良的关联在不同种族之间存在差异，尚未得到评估。本研究通过分层多阶段抽样设计，从 1999 年至 2008 年的全国健康和营养调查中收集了 6147 名年龄≥18 岁的已确诊高血压患者。使用加权逻辑回归模型和线性回归模型，估计了未控制血压的优势比（ORs）、相对 ORs 和 95%置信区间（CIs），以及微量白蛋白尿和大量白蛋白尿对连续血压的不同影响。所有个体种族组中，白蛋白尿患者和大量白蛋白尿患者更有可能出现未控制的血压和更高的平均收缩压（SBP）。微量白蛋白尿与非西班牙裔黑人和白人的孤立性未控制 SBP 有关，而大量白蛋白尿与非西班牙裔黑人的孤立性未控制 SBP、舒张压（DBP）和高平均 DBP 有关。与非西班牙裔白人相比，非西班牙裔黑人和墨西哥人微量白蛋白尿与未控制血压的关联较低（与白人相比，黑人的相对 OR = 0.68，95%CI = 0.48-0.97；墨西哥人的相对 OR = 0.62，95%CI = 0.42-0.93），与孤立性未控制 SBP 的关联也较低（与白人相比，黑人的相对 OR = 0.62，95%CI = 0.43-0.90；墨西哥人的相对 OR = 0.45，95%CI = 0.29-0.71）。与非西班牙裔白人相比，非西班牙裔黑人和墨西哥人的微量白蛋白尿与未控制血压的关联较低。卫生保健提供者需要改善非西班牙裔白种高血压患者轻度升高的白蛋白排泄率的护理水平，同时保持非西班牙裔黑人和墨西哥人的护理质量。
