(Hypertension. 2000;35:48.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Microalbuminuria and Pulse Pressure in Hypertensive and Atherosclerotic Men
From Dipartimento Cardiotoracico (R.P., G.D., M.M.), Malattie del Metabolismo (G.P., S.B.), Medicina Interna (A.B., V.D.B.), Università di Pisa, Pisa, Italy.
Abstract—To identify the
biological covariates of microalbuminuria
(albuminuria 
15 µg/min) in nondiabetic subjects,
brachial blood pressure, echocardiographic left
ventricular mass, and other cardiovascular
and metabolic parameters were evaluated in 211
untreated males (38 normal controls, 109 uncomplicated stage 1 to 3
essential hypertensives, and 64 patients with clinically stable
atherosclerotic peripheral vascular disease either with
[n=44] or without [n=20] essential hypertension) with normal
cardiac and renal function. Compared with normoalbuminuric
subjects, microalbuminuric subjects (n=67) were characterized
by higher systolic blood pressure, comparable
diastolic blood pressure, and, therefore, wider pulse
pressure. Greater prevalence of hypertension, peripheral
vascular disease, left ventricular hypertrophy,
and reduced HDL cholesterol values further distinguished
microalbuminuric from normoalbuminuric subjects in
univariate comparisons. The risk of
microalbuminuria increased by ascending pulse pressure
quintiles in age-corrected logistic regression models, in which pulse
pressure was more predictive than systolic pressure and was
independent of mean pressure. When microalbuminuric status was
regressed against a series of dichotomous (vascular and active smoker
status) and continuous (age, pulse and mean pressure, left
ventricular mass index, and HDL and LDL
cholesterol) variables, only pulse pressure, left
ventricular mass index, and smoking status were independent
predictors. The association of increased albuminuria with
wider pulse pressure, a correlate of the pulsatile
hemodynamic load and conduit vessel stiffness as well
as an important cardiovascular risk factor, may explain
why microalbuminuria predicts
cardiovascular events in nondiabetic subjects. The
independence from concomitant vascular disease also suggests that wider
pulse pressure, rather than representing a simple marker
for atherosclerotic disease, influences albuminuria directly.
Key Words: albuminuria • pressure • hypertension, essential • vascular diseases • mass, ventricular
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