University Hospital Clementino Fraga Filho of the Universidade Federal do Rio de Janeiro, Rua Homem de Melo, 150/102 - CEP 20510-180 - Tijuca, Rio de Janeiro, RJ, Brazil.
J Hum Hypertens. 2018 Feb;32(2):139-149. doi: 10.1038/s41371-017-0013-2. Epub 2017 Dec 11.
Moderately increased albuminuria, defined as urinary albumin excretion rate (UAER) between 30 and 300-mg/24-h is a well-known cardiovascular risk factor, especially in diabetic and hypertensive patients. This study aim to analyze the prognostic value of baseline UAER in a still understudied group, patients with resistant hypertension (RHT). This is a prospective observational study, which had enrolled 1048 outpatients with RHT, who were submitted to a clinical-laboratory assessment and ambulatory blood pressure monitoring (ABPM) during the follow-up. Primary endpoints were a composite of fatal and non-fatal cardiovascular events, all-cause mortality and cardiovascular mortality. Survival analysis by multiple Cox regression assessed the associations among endpoints, baseline UAER, glomerular filtration rate (GFR), and ABPM control. After a mean 7.5 years follow-up, 233 patients died, 120 from cardiac death; 215 cardiovascular events occurred, 90 strokes and 116 coronary diseases. UAER above 30-mg/24-h increased above 40% the risk of fatal and non-fatal cardiovascular events, and of all-cause mortality. At these UAER levels, secondary outcomes were associated to increased risk of stroke and risk of end-stage renal disease, but did not affect coronary events. Both the GFR below 60-mL/min and uncontrolled ABPM were related to nearly two-fold raised risk of fatal and non-fatal cardiovascular events, when coupled with UAER above 30-mg/24-h. In conclusion, moderately increased albuminuria predicts cardiovascular events and all-cause mortality in RHT, and its prognostic impact is enhanced in association with a GFR under 60-mL/min and uncontrolled baseline ABPM.
微量白蛋白尿（定义为尿白蛋白排泄率 [UAER] 在 30 至 300mg/24h 之间）是众所周知的心血管危险因素，尤其是在糖尿病和高血压患者中。本研究旨在分析基线 UAER 在一个研究较少的人群，即耐药性高血压（RHT）患者中的预后价值。这是一项前瞻性观察性研究，共纳入 1048 例 RHT 门诊患者，在随访期间进行临床实验室评估和动态血压监测（ABPM）。主要终点是致命和非致命心血管事件的复合、全因死亡率和心血管死亡率。通过多 Cox 回归的生存分析评估了终点、基线 UAER、肾小球滤过率（GFR）和 ABPM 控制之间的关联。经过平均 7.5 年的随访，233 例患者死亡，120 例死于心脏死亡；发生了 215 例心血管事件，90 例为中风，116 例为冠心病。UAER 超过 30mg/24h 使致命和非致命心血管事件以及全因死亡率的风险增加了 40%以上。在这些 UAER 水平下，次要结局与中风风险和终末期肾病风险增加相关，但与冠状动脉事件无关。当 GFR 低于 60mL/min 和 ABPM 未得到控制时，UAER 超过 30mg/24h 与致命和非致命心血管事件的风险几乎增加了一倍。总之，中度增加的白蛋白尿可预测 RHT 患者的心血管事件和全因死亡率，当与 GFR 低于 60mL/min 和未控制的基线 ABPM 相关时，其预后影响会增强。
