The impact of microalbuminuria measured by qualitative or quantitative methods on risk evaluation in hypertensive patients: Results from ICEBERG study

Abstract

Although microalbuminuria determined by quantitative methods seems to be more accurate, using dipstick is simpler and cheaper, thus making this qualitative method more suitable for screening in primary healthcare settings for hypertensive patients. The primary purpose of Intensive / Initial Cardiovascular Examination regarding Blood pressure levels: Evaluation of Risk Groups (ICEBERG) study protocol is to determine the impact of different laboratory tests on cardiovascular risk stratification of subjects with BP levels ≥130/85 mmHg. This report focuses on the comparison of the impact of quantitative and qualitative microalbuminuria detection on the risk evaluation. ICEBERG is a healthcare organization-based epidemiological study, conducted at 217 centers (20 cardiology -1- and 197 primary healthcare centers -2-). In group 1, microalbuminuria was calculated as urinary albumin/creatinine ratio in random urine samples (quantitative method) and in group 2, urine strips (Micral-test Microalbuminuria®, Roche Diagnostics GmBh) were used (qualitative method). 9268 patients were included in the analysis (765 and 8496 in groups 1 and 2, respectively). Initial risk assessment was performed according to ESC-ESH 2003 guidelines and reassessment was done by using quantitative and qualitative methods. The study patients were 58.4±11.3 years old (female 65.3%). 53.8% and 54.5% of the patients were classified into high (H) or very high (VH) added risk group with baseline evaluation, in groups 1 and 2, respectively. Switching upwards to H/VH risk group was 6.2% and 6.6%, when quantitative and qualitative microalbuminuria tests were taken into account, respectively. Risk group switching upwards were found to be similar in both quantitative and qualitative microalbuminuria groups, thus demonstrating that dipstick microalbuminuria detection has almost the same effectiveness when compared with quantitative.