Bigazzi R, Bianchi S, Baldari D, Campese V M
Unità Operativa, Spedali Riuniti, Livorno, Italy.
J Hypertens. 1998 Sep;16(9):1325-33. doi: 10.1097/00004872-199816090-00014.
Some patients with essential hypertension manifest greater than normal urinary excretion of albumin (UAE). Authors of a few retrospective studies have suggested that there is an association between microalbuminuria and cardiovascular risk.
To evaluate whether microalbuminuria is associated with a greater than normal risk of cardiovascular and renal events.
We performed a retrospective cohort analysis of 141 hypertensive individuals followed up for approximately 7 years. Hypertensive patients were defined as having microalbuminuria if the baseline average UAE of three urine collections was in the range 30-300 mg/24 h.
Fifty-four patients had microalbuminuria and 87 had normal UAE. At baseline, the two groups were similar for age, weight, blood pressure, and rate of clearance of creatinine. Serum levels of cholesterol, triglycerides, and uric acid in patients with microalbuminuria were higher than levels in those with normal UAE, whereas levels of high-density lipoprotein cholesterol in patients with microalbuminuria were lower than levels in patient with normal UAE. During follow-up, 12 cardiovascular events occurred among the 54 (21.3%) patients with microalbuminuria and only two such events among the 87 patients with normal UAE (P < 0.0002). Stepwise logistic regression analysis showed that UAE (P = 0.003), cholesterol level (P = 0.047) and diastolic blood pressure (P = 0.03) were independent predictors of the cardiovascular outcome. Rate of clearance of creatinine from patients with microalbuminuria decreased more than did that from those with normal UAE (decrease of 12.1 +/- 2.77 versus 7.1 +/- 0.88 ml/min, P < 0.03).
This study suggests that hypertensive individuals with microalbuminuria manifest a greater incidence of cardiovascular events and a greater decline in renal function than do patients with normal UAE.
一些原发性高血压患者的尿白蛋白排泄量（UAE）高于正常水平。一些回顾性研究的作者认为微量白蛋白尿与心血管风险之间存在关联。
评估微量白蛋白尿是否与心血管和肾脏事件的风险高于正常水平相关。
我们对141名高血压患者进行了回顾性队列分析，随访约7年。如果三次尿液收集的基线平均UAE在30 - 300 mg/24 h范围内，则高血压患者被定义为患有微量白蛋白尿。
54例患者有微量白蛋白尿，87例UAE正常。在基线时，两组在年龄、体重、血压和肌酐清除率方面相似。微量白蛋白尿患者的血清胆固醇、甘油三酯和尿酸水平高于UAE正常患者，而微量白蛋白尿患者的高密度脂蛋白胆固醇水平低于UAE正常患者。在随访期间，54例（21.3%）微量白蛋白尿患者中有12例发生心血管事件，而87例UAE正常患者中仅有2例发生此类事件（P < 0.0002）。逐步逻辑回归分析表明，UAE（P = 0.003）、胆固醇水平（P = 0.047）和舒张压（P = 0.03）是心血管结局的独立预测因素。微量白蛋白尿患者的肌酐清除率下降幅度大于UAE正常患者（分别下降12.1±2.77与7.1±0.88 ml/min，P < 0.03）。
本研究表明，与UAE正常的患者相比，患有微量白蛋白尿的高血压患者心血管事件发生率更高，肾功能下降幅度更大。
