Hörner D, Fliser D, Klimm H P, Ritz E
Department of Internal Medicine, Ruperto-Carola University, Heidelberg, Germany.
J Hypertens. 1996 May;14(5):655-60. doi: 10.1097/00004872-199605000-00016.
To investigate the rate of albumin excretion and the prevalence of albuminuria in hypertensive individuals relative to the normotensive population, and to clarify the quantitative importance of confounding variables.
We examined the morning urines of all consecutive non-diabetic and diabetic hypertensive patients (n = 631; 371 women, 260 men) attending the offices of five general practitioners in a circumscribed geographical area during a 4-month period. To obtain a normotensive control population, all consecutive visitors (n = 375; 217 women, 158 men) were also examined. Urinary albumin excretion was assessed by kinetic nephrelometry in morning urine samples.
The median albumin excretion rate was 4.3 micrograms/ml (range 1.9-112) in normotensive individuals; 3.4 micrograms/ml (1.9-1440) in hypertensive and 3.6 micrograms/ml (1.9-2790) in diabetic patients (n = 189; 115 women, 74 men). The overall prevalence of albuminuria above 20 micrograms/ml was 4% in normotensive individuals, 10% in hypertensive patients and 17% in diabetic patients. The proportion of patients with higher-grade albuminuria (> 50 micrograms/ml) was 1% among the normotensive subjects aged below 60 years and 2% in those aged above 60 years; the respective values in hypertensive patients were 3 and 6% and in diabetic patients 8 and 13%. The multivariate regression analysis showed a significant correlation between albuminuria and smoking (P < 0.0001), the presence of hypertension (P < 0.001), the current level of systolic blood pressure (P < 0.01) and age (0.031), but not sex or body mass index.
The present study confirms a higher prevalence of albuminuria above 20 micrograms/ml in individuals with primary hypertension and diabetes mellitus compared with that in normotensive subjects, despite similar median albumin excretion rates. However, the excess of prevalence is moderate. Smoking, advanced age and current level of systolic blood pressure are the important determinants.
研究高血压患者相对于血压正常人群的白蛋白排泄率及白蛋白尿患病率，并阐明混杂变量的定量重要性。
我们在4个月期间检查了限定地理区域内5位全科医生诊所中所有连续就诊的非糖尿病和糖尿病高血压患者（n = 631；女性371例，男性260例）的晨尿。为获得血压正常的对照人群，还检查了所有连续就诊者（n = 375；女性217例，男性158例）。通过动态肾测量法评估晨尿样本中的尿白蛋白排泄情况。
血压正常者的白蛋白排泄率中位数为4.3微克/毫升（范围1.9 - 112）；高血压患者为3.4微克/毫升（1.9 - 1440），糖尿病患者（n = 189；女性115例，男性74例）为3.6微克/毫升（1.9 - 2790）。尿白蛋白浓度高于20微克/毫升的总体患病率在血压正常者中为4%，高血压患者中为10%，糖尿病患者中为17%。尿白蛋白水平较高（> 50微克/毫升）的患者比例在60岁以下血压正常者中为1%，60岁以上者中为2%；高血压患者中分别为3%和6%，糖尿病患者中分别为8%和13%。多因素回归分析显示，白蛋白尿与吸烟（P < 0.0001）、高血压的存在（P < 0.001）、当前收缩压水平（P < 0.01）和年龄（P = 0.031）之间存在显著相关性，但与性别或体重指数无关。
本研究证实，尽管原发性高血压和糖尿病患者的白蛋白排泄率中位数与血压正常者相似，但前者尿白蛋白浓度高于20微克/毫升的患病率更高。然而，患病率的增加幅度适中。吸烟、高龄和当前收缩压水平是重要的决定因素。
