Published online before print August 22, 2005, doi: 10.1161/01.HYP.0000178188.29446.48
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(Hypertension. 2005;46:473.)
© 2005 American Heart Association, Inc.
Editorial Commentaries |
Proteinuria
A Link to Understanding Changes in Vascular Compliance?
From the Department of Preventive Medicine, Hypertension Clinical Research Center, Rush University Medical Center, Chicago, Ill.
Correspondence to George L. Bakris, MD, Rush University Medical Center, 1700 W Van Buren St, Suite 470, Chicago, IL 60612. E-mail gbakris@earthlink.net
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Hypertension is a well-known risk factor associated with high cardiovascular risk and kidney disease progression. Proteinuria commonly occurs in concert with hypertension in people with chronic kidney disease (CKD). The spectrum of albuminuria, from microalbuminaria (>30 but <300 mg per day) to macroalbuminuria (proteinuria) (>300 mg per day) is associated with a linear increase in risk of cardiovascular events.1,2 Microalbuminuria correlates with the magnitude of C-reactive protein (CRP) elevations and has also been associated with a failure of nocturnal drops in arterial pressure, insulin resistance, as well as abnormal vascular responsiveness to a variety of stimuli.3–7 Thus, its presence indicates abnormal responses by vascular tissue, perhaps because of underlying inflammatory responses. Together, these data support the concept that microalbuminuria is associated with increased cardiovascular risk and that proteinuria represents even higher cardiovascular risk with high risk for progression to end-stage kidney disease.
Whereas most studies focus on the association between baseline proteinuria and kidney disease progression, others have concentrated on the impact of proteinuria and associated changes in vascular compliance. However, these later studies have focused on microalbuminuria rather than higher levels of proteinuria. In one study of 70 newly diagnosed patients with hypertension demonstrated higher values of carotid-femoral pulse wave velocity (PWV) in those with microalbuminuria. This difference remained statistically significant, even after correction for 24-hour systolic and diastolic blood pressure (BP), and body mass index. Moreover, a tight correlation was found between urinary albumin excretion and carotid-femoral PWV.8 Similar findings were noted in a comparable study cohort as
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  N. Khosla and G. Bakris Lessons Learned from Recent Hypertension Trials about Kidney Disease Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 229 - 235. [Full Text] [PDF]
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