Arterial hypertension, microalbuminuria, and risk of ischemic heart disease
Arterial hypertension, microalbuminuria, and risk of ischemic heart disease
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DOI：
10.1161/01.hyp.35.4.898
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发表时间：
2000-04-01
期刊：
影响因子：
8.3
通讯作者：
Borch-Johnsen, K
中科院分区：
文献类型：
--
作者：
Jensen, JS;Feldt-Rasmussen, B;Borch-Johnsen, K
尿中白蛋白排泄与缺血性心脏病和动脉粥样硬化危险因素的存在呈正相关。我们前瞻性研究了尿白蛋白排泄的轻微增加，即微量白蛋白尿，是否增加了高血压患者缺血性心脏病的风险。在1983年和1984年，对2085名年龄在30 - 60岁、无缺血性心脏病、糖尿病、肾脏或泌尿道疾病受试者进行了血压、尿白蛋白/肌酐浓度比、血浆总胆固醇和HDL胆固醇水平、体重指数和吸烟状况的调查。204名受试者存在未经治疗的动脉高血压或临界高血压，这些受试者由国家医院和死亡证明登记处就缺血性心脏病的发展进行随访，直至1993年。在1978人-年期间，18例（9%）高血压受试者发生缺血性心脏病。微量白蛋白尿，定义为尿白蛋白/肌酐比值高于上十分位数（1.07 mg/mmol）是缺血性心脏病最强的预测因子，未校正的相对危险度为4.2（95% CI 1.5 - 11.9，P=0.006），校正所有其他动脉粥样硬化危险因素（包括年龄和性别）后，相对危险度为3.5（95% CI 1.0 - 12.1，P=0.05）。总之，在高血压或临界高血压患者中，微量白蛋白尿使缺血性心脏病的风险增加4倍。高血压门诊应定期测量尿白蛋白排泄，对伴有微量白蛋白尿的高血压患者建议严格控制血压和其他动脉粥样硬化危险因素。
xAlbumin excretion in urine is positively correlated with the presence of ischemic heart disease and atherosclerotic risk factors. We studied prospectively whether a slight increase of urinary albumin excretion, ie, microalbuminuria, adds to the increased risk of ischemic heart disease among hypertensive subjects. in 1983 and 1984, blood pressure, urinary albumin/creatinine concentration ratio, plasma total and HDL cholesterol levels, body mass index, and smoking status were obtained in a population-based sample of 2085 subjects, aged 30 to 60 years, who were free from ischemic heart disease, diabetes mellitus,and renal or urinary tract disease. Untreated arterial hypertension or borderline hypertension was present in 204 subjects, who were followed until 1993 by the National Hospital and Death Certificate Registers with respect to development of ischemic heart disease. During 1978 person-years, 18 (9%) of the hypertensive subjects developed ischemic heart disease. Microalbuminuria, defined as a urinary albumin/creatinine ratio above the upper decile (1.07 mg/mmol), was the strongest predictor of ischemic heart disease, with an unadjusted relative risk of 4.2 (95% CI 1.5 to 11.9, P=0.006) and a relative risk of 3.5 (95% CI 1.0 to 12.1, P=0.05) when adjusted for all other atherosclerotic risk factors, including age and gender. In conclusion, microalbuminuria confers a 4-fold increased risk of ischemic heart disease among hypertensive or borderline hypertensive subjects. Urinary albumin excretion should be measured regularly in a hypertension clinic, and a rigorous control of` blood pressure and of other atherosclerotic risk factors is recommended in hypertensive patients with microalbuminuria.