Higher brachial-ankle pulse wave velocity as an independent risk factor for future microalbuminuria in patients with essential hypertension: the J-TOPP study

Abstract

Brachial-ankle pulse wave velocity (baPWV) is a new measure of arterial stiffness. We have shown that a higher baPWV is associated with more severe albuminuria in patients with essential hypertension. However, it is still unclear as to whether baPWV predicts the future albuminuria status in patients under standard care. A total of 321 nondiabetic patients with essential hypertension who had normoalbuminuria or microalbuminuria and were receiving treatment under the current hypertension guidelines were followed up for 2 years. Resting BP, fasting blood glucose, urinary albumin excretion and baPWV were measured before treatment, and periodically thereafter for 2 years. A 2-year treatment regimen lowered BP from 156/93 to 135/81 mmHg (P < 0.0001) and reduced the incidence of microalbuminuria from 25.8 to 14.0%. To determine the predictors for future microalbuminuria status, we compared the baseline data between patients with normoalbuminuria (n = 276) and those with microalbuminuria (n = 45) 2 years after the treatment. The microalbuminuric patients had a significantly higher baPWV and urinary albumin excretion and a significantly lower high-density lipoprotein concentration than the normoalbuminuric patients. Furthermore, the frequency of the use of renin-angiotensin system inhibitors was significantly lower in the microalbuminuric patients than in the normoalbuminuric patients. A multiple logistic regression analysis showed that higher baPWV was an independent risk factor for microalbuminuria 2 years after treatment of hypertension. When we restricted our analysis to a cohort of patients without microalbuminuria at the baseline, we found that higher baPWV was an independent predictor of the development of microalbuminuria after 2 years. Higher baPWV could be an independent risk factor for future microalbuminuria in patients with essential hypertension.