Hara Hidehiko, Kougami Kenichi, Shimokawa Kotaro, Nakajima Shunichi, Nakajima Rintaro, Nakamura Ryoichi, Hirahata Koichi, Hoshi Hajime, Nakamura Masato
Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Japan.
Intern Med. 2014;53(12):1275-81. doi: 10.2169/internalmedicine.53.2110. Epub 2014 Jun 15.
A link between urinary albumin excretion and an increased incidence of cardiovascular mortality has already been demonstrated. However, the reported prevalence of microalbuminuria (MAU) in patients with hypertension is highly variable. We therefore aimed to conduct a cross-sectional multicenter study to investigate the prevalence of urinary albumin excretion in treated hypertensive patients in our current practice.
A total of 1,258 hypertensive patients were enrolled in this study. Patients with macroalbuminuria were excluded. The concentrations of urinary microalbumin and creatinine were measured. Urinary albumin excretion was expressed as the ratio of albumin to creatinine excretion.
The mean systolic and diastolic blood pressures were 130.9±12.7 mmHg and 74.7±8.9 mmHg, respectively. The overall prevalence of MAU was 42.8%, and it was observed in 35.8% of patients treated with a single medication. Patients with polyvascular disease exhibited a higher prevalence of MAU compared with patients with monovascular disease. The factors related to the presence of MAU included the estimated glomerular filtration rate (eGFR), systolic blood pressure, and glycated hemoglobin (HbA1c) level (odds ratios [ORs] of 0.988, 1.026, and 1.371, respectively).
The present study showed that the prevalence of MAU among hypertensive patients was 42.8%, even in patients whose blood pressure was relatively well controlled. Additionally, the eGFR, systolic blood pressure, and HbA1c level are risk factors for the development of MAU. These findings suggest that a substantial number of hypertensive patients have MAU and highlight the importance of strictly controlling these factors to improve patient prognosis.
尿白蛋白排泄与心血管死亡率增加之间的联系已得到证实。然而，高血压患者中微量白蛋白尿（MAU）的报告患病率差异很大。因此，我们旨在开展一项横断面多中心研究，以调查在我们当前的医疗实践中接受治疗的高血压患者的尿白蛋白排泄患病率。
本研究共纳入1258例高血压患者。排除大量白蛋白尿患者。测量尿微量白蛋白和肌酐的浓度。尿白蛋白排泄以白蛋白与肌酐排泄的比值表示。
平均收缩压和舒张压分别为130.9±12.7 mmHg和74.7±8.9 mmHg。MAU的总体患病率为42.8%，在单一药物治疗的患者中为35.8%。与单血管疾病患者相比，多血管疾病患者的MAU患病率更高。与MAU存在相关的因素包括估计肾小球滤过率（eGFR）、收缩压和糖化血红蛋白（HbA1c）水平（比值比[OR]分别为0.988、1.026和1.371）。
本研究表明，即使在血压相对得到良好控制的高血压患者中，MAU的患病率仍为42.8%。此外，eGFR、收缩压和HbA1c水平是MAU发生的危险因素。这些发现表明，大量高血压患者存在MAU，并突出了严格控制这些因素以改善患者预后的重要性。
