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(Hypertension. 2005;45:1125.)
© 2005 American Heart Association, Inc.

Original Articles

Long-Term Impact of Systolic Blood Pressure and Glycemia on the Development of Microalbuminuria in Essential Hypertension

Jose Maria Pascual; Enrique Rodilla; Carmen Gonzalez; Santiago Pérez-Hoyos; Josep Redon

From the hypertension clinics of Sagunto Hospital (J.M.P., E.R., C.G.), Valencian School for Health Studies (S.P.H.) and Hospital Clinico (J.R.) University of Valencia, Spain.

Correspondence to Josep Redon, Hypertension Clinic, Internal Medicine, Hospital Clinico, University of Valencia, Avda Blasco Ibañez, 17, 46010 Valencia. E-mail josep.redon{at}uv.es

The objective was to assess the temporal impact of factors related to the development of microalbuminuria during the follow-up of young adult normoalbuminurics with high-normal blood pressure or at stage 1 of essential hypertension. Prospective follow-up was conducted on 245 normoalbuminuric hypertensive subjects (mean age 40.9 years; 134 men; blood pressure 139.7/88.6 mm Hg; body mass index 28.5 kg/m²) never treated previously with antihypertensive drugs, with yearly urinary albumin excretion measurements, until the development of microalbuminuria. After enrollment, patients were placed on usual care including nonpharmacological treatment or with an antihypertensive drug regime to achieve a blood pressure of <135/85 mm Hg. Thirty subjects (12.2%) developed microalbuminuria after a mean follow-up of 29.9 months (range 12 to 144 months), 2.5 per 100 patients per year. Baseline urinary albumin excretion (hazard ratio, 1.07; P=0.006) and systolic blood pressure during the follow-up (hazard ratio, 1.03; P=0.008) were independent factors related to the follow-up urinary albumin excretion in a Cox proportional hazard model. A significant increase in the risk of developing microalbuminuria for urinary albumin excretion at baseline >15 mg per 24-hour systolic blood pressure >139 mm Hg and a positive trend in fasting glucose were observed in the univariate analyses. However, in the multivariate analysis, only the baseline urinary albumin excretion and the trend of fasting glucose were independently related to the risk of developing microalbuminuria. In mild hypertensives, the development of microalbuminuria was linked to insufficient blood pressure control and to a progressive increment of glucose values.

Key Words: hypertension, essential • blood pressure • glucose • microalbuminuria

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