Takase Hiroyuki, Sugiura Tomonori, Ohte Nobuyuki, Dohi Yasuaki
From the Department of Internal Medicine (HT), Enshu Hospital, Hamamatsu; and Department of Cardio-Renal Medicine and Hypertension (TS, NO, YD), Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Medicine (Baltimore). 2015 Feb;94(6):e511. doi: 10.1097/MD.0000000000000511.
We investigated whether urinary albumin could predict the development of hypertension and future increases in blood pressure in the normotensive general population.Normotensive subjects who visited our hospital for a physical checkup (n = 6205, men 61.8%, 53.4 ± 11.4 years old) were enrolled in this study. Urine samples were collected for the measurement of albumin concentration, expressed as the ratio of urinary albumin to creatinine concentrations (UACR [mg/g Cr]). After the baseline examination, subjects were followed up for a median of 1089 days with the endpoint being the development of hypertension.Urinary albumin was in the normal range (UACR <30 mg/g Cr) in most subjects (97.5%). During the follow-up, hypertension developed in 1184 subjects (19.1%, 69.5 per 1000 person-years), with more men than women affected. The incidence of hypertension was increased across the quartiles of UACR by Kaplan-Meier analysis (log-rank, P < 0.0001) and the hazard ratio (lowest quartile [median UACR 1.14 mg/g Cr] as reference) was 1.53 (95% confidence intervals 1.30-1.80) in the highest quartile (median UACR 8.87 mg/g Cr). Multivariate Cox hazard analysis in which UACR was taken as a continuous variable identified UACR as a significant predictor of hypertension (hazard ratio 1.37, 95% CI 1.20-1.56). UACR was also an independent predictor of future increases in systolic blood pressure (P < 0.01).Urinary albumin is an independent predictor of hypertension and increases in blood pressure in the general population even in the normal range below the threshold defined for microalbuminuria.
我们调查了尿白蛋白是否能够预测正常血压的普通人群中高血压的发生以及未来血压的升高情况。本研究纳入了因体检来我院就诊的血压正常受试者（n = 6205，男性占61.8%，年龄53.4±11.4岁）。收集尿液样本以测量白蛋白浓度，以尿白蛋白与肌酐浓度之比（UACR [mg/g Cr]）表示。在基线检查后，对受试者进行了中位时间为1089天的随访，终点为高血压的发生。大多数受试者（97.5%）的尿白蛋白处于正常范围（UACR <30 mg/g Cr）。在随访期间，1184名受试者（19.1%，每1000人年69.5例）发生了高血压，男性受影响的人数多于女性。通过Kaplan-Meier分析，UACR四分位数范围内高血压的发病率呈上升趋势（对数秩检验，P < 0.0001），最高四分位数（中位UACR 8.87 mg/g Cr）的风险比（以最低四分位数[中位UACR 1.14 mg/g Cr]为参照）为1.53（95%置信区间1.30 - 1.80）。将UACR作为连续变量进行多变量Cox风险分析发现，UACR是高血压的显著预测因子（风险比1.37，95% CI 1.20 - 1.56）。UACR也是未来收缩压升高的独立预测因子（P < 0.01）。即使在低于微量白蛋白尿定义阈值的正常范围内，尿白蛋白也是普通人群中高血压和血压升高的独立预测因子。
