Microalbuminuria in treated hypertensives: Only a mirror image of cardiovascular risk?

Abstract

Objectives. Microalbuminuria as an independent marker of cardiovascular morbidity and mortality in hypertensive individuals is under debate. The aim of this study was to study the possible associations between microalbuminuria on one hand and known cardiovascular risk factors and cardiovascular disease on the other hand, in a large, unselected population of treated hypertensives without diabetes. Design. Cross-sectional study. Setting. Participants of the HUNT Study, Norway (n = 65,258). Subjects. 5,369 individuals (≥20 years) with treated hypertension delivered three morning urine samples for microalbuminuria analysis. Main outcome measures. Microalbuminuria expressed as albumin-to-creatinine ratio, cardiovascular risk factors and cardiovascular disease. Results. Increasing age, pulse pressure (systolic blood pressure–diastolic blood pressure), s-creatinine, cigarette pack years, cardiovascular disease, antihypertensive medication group, and years with antihypertensive medication were significantly associated with microalbuminuria in men. Increasing pulse pressure, cigarette pack years, and antihypertensive medication group were associated with microalbuminuria in women, adjusted for other cardiovascular risk factors. When excluding individuals of both sexes with self-reported cardiovascular disease and blood pressure > 160/90 mm Hg, no variable associated with cardiovascular risk factors registered was statistically associated with microalbuminuria. Conclusion. The present study indicates that microalbuminuria mainly represents a mirror image of hypertension (BP > 160/90) and prior or present cardiovascular disease. We therefore question whether the treatment quality would improve if yet another risk factor, microalbuminuria, were introduced as a routine test in treated hypertensives.