Low-Grade Microalbuminuria Predicts Hypertension

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Summary and Comment

Low-Grade Microalbuminuria Predicts Hypertension

Levels of microalbuminuria in people without diabetes or hypertension at baseline predicted incident hypertension and worsening blood pressure.

Microalbuminuria, a marker for glomerular hyperfiltration and endothelial dysfunction, is often seen in patients with diabetes or hypertension. Researchers from the Framingham Heart Study followed 1499 people without diabetes or hypertension to see whether microalbuminuria might predict blood pressure progression and incident hypertension.

After a mean of 2.9 years, 230 study subjects (15%) had developed hypertension, and 499 (33%) had progressed to worse BP categories as defined by standard guidelines. In multivariate analyses, the ratio of albumin to creatinine in the urine predicted incident hypertension. Patients in the highest quartile of albumin/creatinine ratio at baseline had approximately double the risk for hypertension of those in the lowest quartile.

Comment: Although levels of microalbuminuria measured in this study were generally low, they did predict incident hypertension and worsening blood pressure. The authors hypothesize that glomerular endothelial dysfunction, manifested as low-level microalbuminuria, is potentially both a precursor of essential hypertension and an identifier of patients at increased risk for BP progression. Whether measuring microalbuminuria and instituting early intervention can change outcomes remains to be determined.

— Kirsten E. Fleischmann, MD, MPH

Published in Journal Watch General Medicine May 10, 2005