Institute of Hypertension, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Echocardiography, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
J Clin Hypertens (Greenwich). 2020 Dec;22(12):2230-2238. doi: 10.1111/jch.14081. Epub 2020 Oct 21.
The association of albuminuria, as measured by urine albumin-to-creatinine ratio (UACR) concentration, with subclinical cardiac dysfunction in hypertensive patients is unclear. Our study aimed to examine its relationship in hypertensive patients compared with that in normotensive patients. The study participants were recruited from Danyang, a city of Jiangsu Province from 2017 to 2019. Categorical and continuous analyses were performed with sex-specific UACR tertiles and natural logarithmically transformed UACR, respectively. Comprehensive echocardiography including conventional imaging, tissue Doppler imaging, and 2D speckle tracking was performed using Philips CX50 device. The 2857 participants (mean age = 52.7 ± 11.8 years) included 1673 (58.6%) women, 1125 (39.4%) hypertensive patients, 546 (19.1%) patients with microalbuminuria, and 38 (1.3%) patients with macroalbuminuria. Comorbidities were increasingly prevalent across the tertiles of UACR. Increased left ventricular (LV) mass index, decreased global longitudinal strain (GLS) and LV ejection fraction, lower E/A ratio and e' velocity, and higher E/e' ratio were significantly associated with higher UACR on unadjusted analyses (p ≤ .01). After adjustment for covariates, UACR was only independently associated with lower GLS (tertile 3 = 20.7% vs. tertile 1 = 20.9%; p = .04). The results of hypertensive patients (p ≤ .04) but not normotensive patients (p ≥ .16) were similar to those of the total cohort. Subgroup analyses revealed similar results in patients without coronary artery disease, or without LV hypertrophy, or without diabetes. In conclusion, increased UACR is associated with worse subclinical systolic function in Chinese hypertensive patients but not in normotensive participants.
白蛋白尿与亚临床心功能障碍的关系，通过尿白蛋白与肌酐比值（UACR）浓度来衡量，在高血压患者中尚不清楚。我们的研究旨在检查其与高血压患者的关系，并与正常血压患者进行比较。研究参与者是从江苏省丹阳市招募的，招募时间为 2017 年至 2019 年。使用性别特异性 UACR 三分位数和自然对数转换后的 UACR 分别进行分类和连续分析。使用飞利浦 CX50 设备进行全面的超声心动图检查，包括常规成像、组织多普勒成像和 2D 斑点追踪。2857 名参与者（平均年龄 52.7±11.8 岁）包括 1673 名（58.6%）女性、1125 名（39.4%）高血压患者、546 名（19.1%）微量白蛋白尿患者和 38 名（1.3%）大量白蛋白尿患者。随着 UACR 三分位数的增加，合并症的患病率也越来越高。在未调整分析中，左心室（LV）质量指数增加、整体纵向应变（GLS）和 LV 射血分数降低、E/A 比值和 e'速度降低以及 E/e'比值升高与 UACR 升高显著相关（p≤.01）。在校正协变量后，UACR 仅与较低的 GLS 独立相关（三分位数 3=20.7% vs. 三分位数 1=20.9%；p=0.04）。高血压患者（p≤.04）而不是正常血压患者（p≥.16）的结果与总队列相似。亚组分析显示，在无冠状动脉疾病、无左心室肥厚或无糖尿病的患者中，结果相似。总之，在中国高血压患者中，UACR 升高与亚临床收缩功能恶化相关，但在正常血压患者中无此相关性。
