Agewall S, Wikstrand J, Ljungman S, Herlitz H, Fagerberg B
Department of Medicine, Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg University, Sweden.
Am J Hypertens. 1995 Apr;8(4 Pt 1):337-42. doi: 10.1016/0895-7061(94)00246-8.
The aim of this study was to investigate the predictive value of microalbuminuria (overnight urinary albumin excretion rate 17 to 100 mg/12 h) as a risk factor for future major cardiovascular events in nondiabetic patients with treated hypertension in a prospective study with follow-up time of 3.3 years. Overnight urinary albumin excretion was measured in 345 nondiabetic treated hypertensive men, aged 50 to 72 years, either with a serum cholesterol of > or = 6.5 mmol/L or smokers, or both. Cardiovascular morbidity was closely recorded during the follow-up period. At entry, microalbuminuria was found in 84 patients (24.3%) and 12 patients had macroalbuminuria (3.5%). During the follow-up period there were no differences in new cardiovascular events between patients with microalbuminuria and those with normoalbuminuria. However, an increase in the risk of future major cardiovascular events occurred in patients with urinary albumin excretion above 100 mg/12 h (macroalbuminuria). In a Cox regression analysis urinary albumin excretion was not associated with the incidence of future major cardiovascular events unless a more detailed approach was used, showing that this was the case for urinary albumin excretion above 100 mg/12 h (macroalbuminuria). Calculations with an alternative definition of microalbuminuria and mortality as end-point did not change the principal result. In conclusion, microalbuminuria does not seem to be a predictor of future mortality and cardiovascular morbidity in nondiabetic men with treated hypertension and at high risk of coronary heart disease. However, macroalbuminuria was associated with future major cardiovascular events in this group of patients.
本研究旨在通过一项随访时间为3.3年的前瞻性研究，调查微量白蛋白尿（夜间尿白蛋白排泄率为17至100mg/12h）作为已接受治疗的非糖尿病高血压患者未来发生重大心血管事件风险因素的预测价值。对345名年龄在50至72岁之间、血清胆固醇≥6.5mmol/L或为吸烟者或两者兼具的已接受治疗的非糖尿病男性高血压患者进行了夜间尿白蛋白排泄测定。在随访期间密切记录心血管疾病发病率。入组时，84例患者（24.3%）存在微量白蛋白尿，12例患者存在大量白蛋白尿（3.5%）。在随访期间，微量白蛋白尿患者和正常白蛋白尿患者之间的新发心血管事件无差异。然而，尿白蛋白排泄超过100mg/12h（大量白蛋白尿）的患者未来发生重大心血管事件的风险增加。在Cox回归分析中，除非采用更详细的方法，尿白蛋白排泄与未来重大心血管事件的发生率无关，这表明尿白蛋白排泄超过100mg/12h（大量白蛋白尿）的情况就是如此。以微量白蛋白尿的另一种定义和死亡率作为终点进行计算并未改变主要结果。总之，微量白蛋白尿似乎并不是已接受治疗且有冠心病高风险的非糖尿病男性高血压患者未来死亡率和心血管疾病发病率的预测指标。然而，在这组患者中，大量白蛋白尿与未来重大心血管事件相关。
